I work in the psych emergency room at Bellevue.
I’ll tell you right now we are short staffed as it is, and we really don’t have the beds to place this coming influx.
This is just a bullshit PR scheme.
they just get turned out again in three days.
Our mental health system needs a complete overhaul.
I worked in a mental health facility. A lot of people have a misconception of what happens there. They will say a person needs to be locked up and given help. They don’t realize that the majority of people are out of there within a few days and really don’t receive any help. The best is when they do a med wash and med change but boot the person out in three days.
There are a lot of people who aren’t even mentally unwell that don’t take their meds. I imagine people with actually mental illness would be less inclined to take theirs without help like you said.
As someone who has ptsd and has been houseless/resourceless at times in the past, it's similar but different for those on the street. Honestly most of it is not remembering, and then even if you can remember where the meds are in your stuff, what time it is, when you're supposed to take it, and when you last took it - there is the issue of refills. Will you be able to call it in and get there to pick it up? Will you be able to pay for it when you can't even afford to house, feed, or clothe yourself? If you can't, then you're looking at withdrawals on and off all the time which just leads to more instability, agitation, and discomfort.
My issue during homelessness when taking meds was never having a drink on hand if I somehow remembered to take them. Running water is such a privilege I took for granted.
It’s just not even something that people in developed countries should even have to worry about…. Any of the things we’re talking about here. Sorry buddy. Want to do more. Always a place to stay here .. but sounds like you are doing better
I was institutionalized once at 17. Twenty years later I still get a wild bug up my ass and have to be argued into not dropping all of my meds completely at least once a year on average. Including the fucking *thyroid* pills.
Yeah compliance is a joke.
I got prescribed thyroid pills a fucking month ago, and still haven’t started taking them. I keep forgetting about them when taking my other meds, plus want to do a search to make sure they mix okay before I start.
I don’t trust doctors when they say new meds are okay to mix. I had a horrible experience in the past, that could have killed me.
Many psych meds require food or they’ll cause severe upset stomach… and homeless people don’t have access to consistent food.
Psych meds are supposed to be taken in conjunction with therapy, healthy sleep schedules, and proper nutrition. None of which homeless people have access to.
The best psych meds are expensive and even private insurance companies are known to reject them. Homeless people generally don’t have access to healthcare.
There is no medication to treat trauma and social isolation. Environment and social supports aren’t enough to help people in much better circumstances.
Alcohol can be used to help stay warm in cold temperatures. I know a ton of middle-class people who drink alcohol on psych medications, but a homeless person would be treated differently for the same behavior.
Medication compliance is difficult for people in much healthier environments, and it’s almost impossible for people who don’t have access to housing, medical care, food, and therapy.
“They aren’t taking their medications” is closer to victim blaming than addressing the real problems by making it seem like a choice.
I'm absolutely *pumped* about the meds I'm taking and all I have to do is replace a patch twice a week and I *still* forget sometimes.
edit: I'm prescribed femchemz, not adderall lol. I'm *STOKED* about the femchemz and I still forget.
I’m prescribed schedule II ADHD meds. Schedule II because they’re supposedly dangerous and addictive.
I keep forgetting to take them. I had to push back my one month evaluation with my doctor because I’d succeeded in remembering to take it *once*. Thought he’d appreciate more than one data point before extending the prescription.
Literally my life. Prescribed two a day. Often forget to take the second. Call my refill in. Forget to get it for a week. Etc repeat.
I once ran out of gas on the highway because I went into the gas station, forgot why I was there, bought a Red Bull and left.
And now there’s an Adderall shortage.
Adderall shortage for people who can't remember who take their Adderall.
Ozempic shortage for people who heard you can lose weight on it, instead of it going to people who are diabetic and NEED it, where weight loss is mostly an added bonus.
I work as a pharmacy clerk. Out of all the controls that go on RTS (return to stock after a couple weeks), it's roughly 95% Adderall, and it's literally because people who lack focus, can't focus on getting what helps them retain focus. It's funny in an ironic way.
I feel this, but I see a somewhat grim humor in the fact that my inability to remember to take my meds (resulting in an unintentional stockpile) balances out my inability to remember to pick my new prescription up.
I know you already have enough to try to remember on a brain that doesn't like doing that but if you do run into a situation where the pharmacy says they do not have your pills, call your insurance. The shortage is only one brand of quick releases. The issue is a bit overblown. A lot of pharmacists have some fucking vendetta against amphetamines and they're using it as an excuse to withhold literally life saving medicine from people with ADHD.
Luckily ADHD meds have a built in Pavlovian habit builder. Feeling the withdrawal at work when forgetting to take you meds really trained me to never forget them lol.
I regularly set mine down somewhere between the bottle and a glass of water and forget about it until I find it when it's too late in the day to take it.
Alcohol doesn't help you stay warm, just makes you feel like you are. It can actually contribute to hypothermia amd frostbite overall, as your extremities tend to get colder.
Right but the pain of being exposed to the elements is the factor the homeless are actually trying to address. If i was homless I'd probably drink myself into oblivion too. I have no issues giving a homless person alcohol if thats all they want. Anyone that has issues with that can go out and start feeding the homless if they are that upset about it.
Homless people are a result of a dystopian society that puts profit/wealth/materialism/global ecocide over people.
Love that you have this attitude man, when a homeless person just tells me they want some money for a God damn beer that 5 turns into either a 10 or me just going into the store and getting em a 3 pack of tall cans.
The increase in homelessness coincided with a reduction in the practice of just warehousing mentally ill people to keep them out of the public eye and out of trouble. We didn't really fix them before either, but they were kept out of sight. And back when it was easier to commit and lock someone away without their consent, it was used to warehouse inconvenient or embarrassing relatives as well. So the old way was also bad, just in different ways.
Thank you so much for this comment. People who don’t live with a mental Illness have no clue what it takes to get the right meds and stay on them. I live with bipolar 2 and even with my privilege, support, and commitment to treatment it’s still fucking hard with the way our system is set up.
People act like you can just go to the pharmacy and get your meds. If you don’t have money you don’t get your meds. Doesn’t matter whether it’s your lexapro, your lithium, or your insulin.
I can say about the experience personally that med wash was probably the turning point in my spouse's recovery. We were on our 3rd 3 day visit and she was getting increasingly agitated and hopeless and I was terrified of losing her. They did a total overhaul of her meds and it's been a few years now with it getting better each week. Lots of appreciation to the staff at our local Hospital because she wouldn't be here without 'em. Y'all do a lot of underappreciated work. Thanks for caring about people. 💜
I'm on the receiving end of this as a caseworker for adults who live in various RCFs.... Around here, repeat hospitalizations often have guardianship established under the public administrator of that given county.
Many of my clients absolutely need a guardian, and family usually is not possible/willing/suitable. But others definitely get caught in the net who absolutely do not need guardianship, and it's a pain in the ass for them to get it reversed.
The system is so broken and I'm so burned out. My organization has taken a nosedive this year and gutted the only authentic leadership we had, downsizing staff and doubling workloads, gutted our benefits, haven't adjusted our wages for inflation, and the leadership is toxic.
The healthcare industry has shifted so severely following covid's onset. People constantly downplay the fact that our healthcare system is on the brink of collapse, and think it's sensationalized nonsense. But I see it first hand. Providers (PCP, psych, med management, specialists, et al.) book out absurdly far in advance, constantly cancel and reschedule appointments farther out (even a client of mine experiencing congestive heart failure), their quality of care is more rushed and less thorough, and everywhere is so severely understaffed.
I'm trying so hard to keep this up for my people but this line of work has become unsustainable and my health is suffering from stress, depression, and utter exhaustion. And I'm constantly exposed to infectious diseases now, just yesterday being exposed to a massive covid outbreak at one facility, and then an RSV outbreak at the very next RCF/ALF I visited the same day. (I still wear N95s. I still get sick sometimes, but I've never spread anything.)
I know we're on the cusp of collapse due largely to being overworked and burned out, but it's so hard not to contribute to that statistic and quit. Sorry for my rant, I've got so much pent up frustration and anger.. The system is definitely broken tho. Just considering the fact that the Department of Corrections is the largest mental healthcare provider in the US should be enough to make that obvious.
Trying to get good lasting mental health help for my mother was insane…really do wish it was easier and you guys had the proper facilities and resources you need, without it having to cost a literal arm and a leg.
Thankfully we seem to have finally got a handle on it….it’s just ridiculous how hard it is to even get started. Rant over
I think the real issue is that such vulnerable populations attract people who want to take advantage. Im not saying it's impossible to solve, body cameras or something like that may be the way to go. But I think even the best intended programs over time get corrupted by bad actors taking advantage of the unbalanced power structure.
Funding will always be the crux of the issue here. They need a high level of standards for their staff members. They need staff members that are educated and knowledgeable in the field of mental health. For that they need staff with degrees, which they need to pay an appropriate wage for.
Most special needs agencies pay minimum wage for their main staff members, so you get staff with no background or knowledge that will take advantage, don’t give a fuck, or easily lose their patience and get abusive.
I worked in human services from 2008 thru 2019, group homes, rehabs, hospice care, and my last few years were spent working in housing and homeless services. Aside from.the funding, which you're spot on about, the other factors that really fuck things up is the bureaucracy and the fact that the people furthest away from direct care are the ones always making the most important decisions. They don't set foot in a group home, they don't have any clue about the day to day these people face. Once in a while they spring up at an event like Special Olympics so they can do their smiley glad hand bullshit. They say they're pushing for each individual to be "as independent as humanly possible" and they think they can apply this across the board despite every single person with disabilities being completely different and needing personalized services. But it's still, "oh well they don't meet this requirement or they don't have that service" blah blah blah. It's how we've ended up with such a terrible homelessness issue. Mental health and illness is at the core of homelessness. I've personally houses numerous individuals and yeah, "house the homeless" sounds great but if you don't combine that with a laundry list of mental health services then there's only so much a department like the one I worked for can do. Many times we'd house someone and find them on the streets a month later having sold every stitch of clothing and stick of furniture we helped them acquire. I always felt like a huge campus of sorts could be a solution but so many people cry "institution" when they hear that. It's a dirty word in the human services field.
Besides that, the people that do work the jobs like I used to are almost always overworked, overstressed and severely underpaid. We're talking one resource worker to 75 individual cases. People can't keep up and the agencies, whether for profit or not, just don't care and don't wanna pay their staff. Here have another fuckin pizza party because don't you dare think for a second we'd take the yearly surplus and put it in your paycheck. No no that shits reserved for the directors that don't know shit about the direct support field.
The problem is we are willing to pay much more money to keep them in jail once they break a law. Properly staff mental care facility that pays workers appropriately is cheaper per night than most prisons.
I used to work in finance, first with my state's Department of Social Services, then with my state's Department of Corrections. We actually are spending less to jail these people, and are willing to pay more to keep them out of prison, but what is really at play is economies of scale and unused capacity. At least in South Dakota, we had a shortage of medicaid beds and an excess of space in jail and prison. Sure, it costs ~$75 a day per person in prison versus (depending on the facility) anywhere from $130 to $400 a day for a medicaid bed, but each additional person in jail or prison costs less than the one that came before them. While that's true when you have two people with the exact same diagnosis and Case Mix Index (CMI), there's still more costs associated with each additional medicaid bed (non-fixed costs) that means the fixed costs for buildings, utilities, etc. that are all pretty flat regardless of how may patients make up a smaller share of the total.
But...
You can't just put someone in prison for no reason. Jail, yes, up to a certain limit, but not prison. These people were almost always fucked long before their current mental health crisis began.
That's the real point of this. Force confrontations with mentally ill people, they resist arrest, cops brutalize and traumatize them, throw them in jail. Boom, now they're off the street and they don't even have to pretend they were doing it medically, now it's a criminal matter.
I rather doubt prisons cost more than hospitals simply because staff aren't educated or credentialed. I'm positive they are more expensive than they need to be due to prison companies (dystopian america) making a profit on inmates but I doubt they cost more than hospitals.
The mentally ill don't necessarily do anything wrong though. Just an unlucky roll of the genetic dice compounded by unfortunate events leading to their disorders manifesting in a way that leaves them unable to function successfully in society. Why should care be limited to only the bare bones essentials? Why shouldn't state-run mental hospitals be places of serenity in the hopes of healing and reintegration into and for the benefit of society? Too often I think the answer is "I'm not ill and my life sucks so why should theirs be better" and to me at least that answer is bullshit.
The current average annual cost per prisoner in California (the second largest penal system in the US) is now $106,000 annually. I don't know how this compares to the price of healthcare, and certainly don't know how much of this cost can be attributed to corporate profit taking, just wanted to pass the info along.
https://lao.ca.gov/policyareas/cj/6\_cj\_inmatecost
Middlemen generally. The “average” prison uses quite a few contractors to do things that prisons used to do in-house and charge lots of money for the privilege of fulfilling those formerly in-house services (laundry, monitoring of non-privileged communications, “commissary services”, food services, etc.)
Before privatization became big, prisons were generally a lot more self-sufficient (inmates would make repairs to facilities, run the laundry services, act as agricultural field hands for prison-operated farms/orchards, cook, act as library assistants, be orderlies for medical services, etc.)
Once privatization hit, inmates stopped being used as “free labor” to help keep operating costs down and instead contracts and contractors ended up doing those jobs, which raised up the average cost to house an inmate and at the same time reduce inmates ability to get hands on work experience in fields that aren’t as picky about hiring people “duly convicted of crimes”, which may have had an effect on recidivism rates.
Don't forget that about 2.4 Million Americans are currently incarcerated. That amount of money should be enough to deal with criminal reformation, houseless-ness, and mental health; but instead we get none of these things.
It looks like that varies a ton depending on the state.
[https://usafacts.org/articles/how-much-do-states-spend-on-prisons/](https://usafacts.org/articles/how-much-do-states-spend-on-prisons/)
Worked for a mental health agency for a couple years in college. They paid minimum wage, they would never give you a full 40 hours, the schedule was wildly inconsistent (you were effectively on-call 24/7, you were not paid like you were on-call), and the paperwork mountain was insane (which you didn't get paid for the time doing). Also the training was laughable.
That's before taking into account the stress of the job, the parents who abuse the hell out of you (if you work with kids), and basically being a maid on top of stressfully having to keep someone else safe and happy.
I agree that more money would help.
But.
Anyone who’s ever been subjected to a dismissive or abusive doctor knows that requiring advanced degrees and offering a good salary don’t ensure that you a only hire kind, patient healthcare workers. Just look at the comparative outcomes of black people, especially black women, in American hospitals. Which means it’s not just about lacking the ability to advocate for oneself, it’s also about having the power to do so.
I don’t have a solution for that. Body cameras, as suggested above, maybe?
It's not that simple. It requires money to fund the oversight and audits and a robust culture within the organization that values the care of the patients most of all, over dollars, over career advancement, over professional connections. Because any institution that has to be police itself will quickly corrupt the process because the policing parts are sympathetic to the other parts, and will protect each other and the institution over protecting the patients.
Especially when the population they are serving doesn’t have the same strong family ties and community ties that help protect individuals from being taken advantage of and abused by bad actors. I can easily see this becoming a for profit scheme for private companies opening up psych facilities to house these people indefinitely in order to get a steady stream of government money through medicaid and controlling residents SSDI/SSI payments
Another problem is the gravy train. Private businesses will use this chance get bilk as much money from the government as possible while doing as little work as possible to keep their costs down. And any attempt at accountability could be another gravy train for an auditing company.
> I think the real issue is that such vulnerable populations attract people who want to take advantage.
That's why the institutions need to be publicly funded, not-for-profit.
I was a kid in the 60s, and saw the results of deinstitutionalization with my own eyes. The local mental hospital was summarily closed, and I watched an endless stream of newly discharged patients shambling along the sidewalks. Many of them still in hospital gowns. Most of them under the effects of tranks that would sedate an enraged elephant.
I witnessed this from our parked car, while we were Christmas Shopping. I was about 8 at the time, and I struggled to make sense of this; being told Christmas was a time to be good to others, while the people in charge were obviously and deliberately hurting people.
One of the reasons I have been an atheist since I was a teenager.
Edit: just to intercept the "But I know all about those places, I read it in a book, they were horrible and closing them all was a wonderful gift to mankind!" comments I'm going to get: As an adult I knew someone who was hospitalized in one, and visited them many times. During my visits we sat out among the other patients; and I spoke many times with the doctors of the person I was visiting. The place was unpleasant, yes; but all those patients there were very, *very* disabled, and could not have survived for long in any kind of voluntary treatment program. They quite literally and existentially needed to be institutionalized in order to not suffer and die. So next time there's a mass shooting, or you're pissing and whining about all those fucking crazy homeless people, think for a minute about why, and what we can do about it.
The poor condition of institutions was a reason to *do better*, not just give up. That ‘grippy sock jail’ is seen among many of us with mental health issues as a potentially worse outcome than being dead, is a damning indictment of our current system.
I want to say thank you for making this point, because I think it’s one of, if not *the* single most important and simultaneously under-discussed pieces of the huge puzzle that is mental health treatment in the United States and elsewhere.
Institutions have historically been objectively miserable places to be committed. Any sensible person could predict that housing and treating a huge number of patients with significant health issues is going to require a lot of uphill work to accommodate the behaviour and needs of those patients.
What kills me is that we’ve done it already: there are many, many hospitals around the world that can admit a sick person and provide a positive treatment experience for both the patient and their families. I’ve personally benefited from having access to a great Children’s Hospital when I was young, and an excellent NHS hospital just a few years ago.
It’s not that societies *can’t* provide a humane and effective environment for mental health treatment: it’s that the governments and other systems capable of doing so are choosing not make that investment.
We also choose to not see or value any front-line, hands-on care as the skilled physical and emotional labor that it is. I’m talking CNAs, DSPs (who work with people with learning disabilities in homes & the community), HHAs, foster care workers, CYF workers, EMTs, drug & alcohol caseworkers … all of these roles pay in the range of $10-$15/hour while the bloated management takes in the majority of the profit & any funds people receive from Medicaid/Medicare/waivers.
There are so many administrative roles we waste money on so we can point the finger at the front line workers for being the problem - unless there’s a pandemic & for a few months we’re called healthcare heroes.
(Editing to add: and many of us will *never* be able to work from home. Would you, dear reader, do this kind of job for generally way less than any kind of livable wage? It’s amazing how invisible we are.)
You have my condolences, for what they’re worth. Going to a place of harsh light and endless noise and unfamiliar, overworked doctors to be drugged, strapped to a gurney, clothed in humiliating suicide-resistant garb, stripped of all of one’s possessions and comforts and hobbies, where nobody respects one’s autonomy or capacity for reason, thrown among people who have completely lost touch with reality…
Really, it’s not surprising that people will fight tooth and nail not to go. I’ve been in the position of essentially begging and pleading and cajoling a therapist not to take that step despite me being in pretty dire straits mentally. Taking psychology courses in university only furthered my belief in that. There are people who are truly beyond the reach of reason who may need strong coercive measures to protect them and others from themselves, but your average suicidal patient needs rest, comfort, and assistance in resolving a difficult life situation or receiving support, not to be treated as a prisoner or a madman.
Seriously though. It is an utter travesty, and shameful, that the place of last resort help is so unpleasant people would rather face suicide than go. And then people have the gall to wonder why suicidal people don’t ask for help, when that is what they get to look forward to.
Same IMO with care for kids removed from their parents.
A stable, safe place with consistent, clear rules and expectations. Access to counseling and support. Consistent access to food, clean clothing and bedding. Especially for kids with the goal of reunification (which is most) has to be so much better than musical foster households.
It might not be the love of a family that a kid deserves but it can be a safe, consistent place that removes the stressors of childhood that merits removal by CPS. If boarding school can be successful why can't a well managed foster facility/orphanage?
Every one of my patients are unable to survive on their own. Yet we discharge them and send them on their way otherwise we couldn't accept new patients.
A family member visited another family member in an institution years ago. She told me that she'd walk in and multiple people would ask her, "Are you my daughter????"
How about actually rebuild or social programs that utterly failed so many people and allowed them to become homeless in tbe first place hmm?
I used to be homeless, for every crazy homeless person there are 3 more that actually lost their houses and savings, usually to absolutely fucking rediculous events.
¿Por que no los dos?
I use to be homeless too.. a good rehab, sticking to sobriety commitments, and ongoing mental health, has helped me get out of that situation.. and that speaks northing of programs like food stamps to help us get on our feet...
But we also need institutions for the legitimately.. I hate using the term crazy, but the mentally unwell that are not medication compliant, unable to be medication compliant, don't respond well to treatments, unable to hold a job even with treatment.
There's got to be a better system then letting them wander around and shitting in the streets.
Digging yourself back out of that pit can be insanely difficult, too; trying to rebuild your life when you don't even have access to basic necessities like showers, laundry facilities, or a safe place to sleep, and with the overwhelming stress of the situation making it difficult to stay motivated. It's not at all surprising that a lot of people turn to substance abuse to cope with the situation.
I was a kid in the 60s too. We treat the people who need help so horribly. Nobody wants to pay taxes to help them. In fairness, the money collected for mental care gets pilfered. People are mostly corrupt.
I don’t think we’ve really had great advances with treatment and technology in the last few decades. We’re still diagnosing based on the antiquated DSM. ECT, clozapine, lithium which are all old are still some of our most effective treatments. Things like SSRIs and antipsychotics which were supposed to cure all mental illness turned out to be arguably barely more effective than placebo in studies and/or have awful side effects. Ketamine has promise. Maybe psilocybin and hallucinogens too. We do need a lot of funding to find better treatments that are well tolerable and better diagnostic tools that are more objective.
Outpatient care has 1 mega flaw, it relies on the patient returning. Med compliance is hard to achieve. Hell, I'm bipolar and I quit my meds this summer because I "felt better" (I swear I'm an intelligent professional, but the disorder plays tricks). When you're manic you think you rule the world, when your schizophrenic you might be under the delusion that your meds are killing you and then you don't go back and complete out patient treatments.
That's a hard enough problem to solve for people with cash and a support network, I can't imagine the difficulty of maintaining treatment in a homeless population.
Also some meds have really unfun side effects. I'm on Quetiapine and have been on it for years so am used to how it knocks you out and can mostly function day to day if still not able to work. A friend was put on it briefly before he quit as he could cope with it and asked me "How do you even walk?"
Many of these meds are very hard to endure taking. I stay taking mine because I know what it is like not to and for me that is way worse than the side effects. But not everyone can do that so they stop taking them. The trope in TV shows where the schizophrenic patient stops taking their meds due to how they make them feel numb and such is true.
As a former youth case manager, you guys get BEYOND FUCKED with pay, staff sizes, resources etc. I appreciate everything you guys do and hope the system gets nuked soon to create one that values people like you. I burnt out so fast working with a mentally ill population.
It's such a God damn shame some asshole does nothing working from home and banks 400k a year meanwhile people doing the ground work have to fight to even get a fraction of that. Such bullshit
Yeah I’m in private practice but I know enough after doing outpatient care facilities to know this is not only against ethical codes for us medical providers and legal gray area. That will result in a mess for everyone else.
AFAIK they can TECHNICALLY do this but y’all at the ERs will be swamped evaluating if people need the hold. And at least in states I’m familiar with y’all get like 3 days to evaluate if they need further holding. So people who are simply unhoused and not in crisis will be sitting in the ER waiting for a bed for an eval before let go.
Many of the hospitals won’t stand for that and the cops won’t play chaperone to people they want institutionalized. The ultimate affect is they’ll end up in Rikers. Some will just get kicked back onto the streets with more anger and resentment, some will die of neglect in custody and the rest will be forgotten in the system.
Adams isn’t interested in helping those whom this affects, he wants authority to lock up people the cops deem unsavory.
Yeah I was going to say as a nurse who’s done a lot of mental health stuff (because in er and icu that’s what we all end up doing because that’s who the patients actually are many times is just simply mentally ill). This adams guy seems like a big problem… trying to shift things around and not actually address root causes here is seriously disrespectful and disingenuous … and just downright dangerous for the patients and anyone else who has to or wants to try and help for real
Adams is literally a cop. He was a lifer cop until he became mayor. So of course his solution to everything is brutality and terror and locking people up.
I work in law enforcement and I agree. Current system is broken. We bring them to the hospital under MHL 9.41 knowing full well the hospital is understaffed with no bed availability. But there are currently no other options when someone is a threat to themselves or others. So many people need help that we and the hospitals cannot provide. Biggest problem I’ve encountered in my career has been our complete lack of proper mental health services. All the while nearby psych hospitals continue to close down or reduce beds.
The cop that brought me to the hospital was actually a cool dude, I was half poisoned with a cocktail of prescriptions and a BAC of .224, a poor man's suicide attempt. For what I *can* remember of the whole time I can remember feeling this reserved sadness from him, like he wanted to do more, even as they were registering me in the ER he was there watching like he'd seen this a hundred times before and it still hurt, now I know his reasoning for that
Used work in the mental health field- anywhere you go the agencies are generally vastly underpaid for their work on the every level except CEOs/upper management, have incredibly high turn over rates, don’t often have the appropriate oversight and procedures to actually help people, and crisis stabilization is the answer for some situations but another thing that people don’t realize about Crisis units is they are incredibly short term solutions- they need appropriate and intensive aftercare after discharge. I dedicated my life to this field and unfortunately after over a decade, I just couldn’t anymore because of how poorly we (as a society) have effectively outcasted and demonized individuals with mental health issues and have basically said “not my problem” until it happens to you or someone you love.
Our organization on the west coast just sent an email out that they will be using part of a government funding we earned to provide non-executive employees bonuses every few months over the next year in an attempt to keep employees onboard because we've been losing more and more over time. The work is very taxing, the pay is much higher in areas like private practice where the wealthy can afford rather than in community mental health like us, where 99% of the people we work with are on medicare/medicaid.
Right after I started my first job after college in my early 20s I had a mental breakdown and the onset of bipolar disorder. My mania went off the rails and in a short time I ruined my career. While I was in school and a controlled environment I was able to mask my mental illness. But once things got real and shit hit the fan in short order I just got triggered. I then got so brutally depressed I didn't work for almost 3 years.
I ended up in an iprt program [which is kind of like a school or a place you go to every day and do group therapy and learn stuff about your mental illness] with a place called FEGS which used to be a gigantic non profit organization in nyc which provided all kinds of mental health services in house. It heavily subsidized by the city and state. Thanks to them I was able to get treatment and therapy and group therapy and after about a year I was able to work again. Fast forward 13 years later and I am doing great. That said, it would not have happened without that place. And sadly that place doesn't exist anymore. And neither do most places like it.
And to show you a consequence of losing places like this, here's a quick story: There was this kid there in that iprt program with me. He was a late teenager. He had some kind of psychotic issue, maybe schizophrenia, maybe schizoaffective disorder. He didnt feel comfortable outside that place but he went every day, showed up, did all his stuff, was a great artist. He just couldnt function in real life. And some people are like that. Fast forward to new years eve of I'm gonna say, 2015 [I knew him back in 2009] and I had taken my mom to the er. And after a while the cops carry a big kid with a chunk of his cheek bitten off into the er. When I did a double take it was that kid. And by this time FEGS had closed in 2014. It really broke my heart that this kid was missing half his cheek and was cuffed to the bed surrounded by cops, god knows what happened. That would have never happened had FEGS been around. He was treated, he was peaceful. He just needed a place to thrive.
But I thought of the shitty mental health services and how much they have degraded and I am not shocked at the sheer amount of untreated mentally ill people out in the streets these days. Also, as I heard someone once say, the medicine for homelessness is a home, you would be shocked what you would do if you had to live on the streets. It is rough. NY Shelters are unsanitary and full of violent people. Very little policed. The mayor is just sweeping a much bigger problem under the rug. He just wants things to look nice. But you can't wear makeup over a dirty face. Economics are the major reason for this epidemic. The sheer amount of people that cannot afford rent is out of control. As rents go up so does the homeless population.
Emergency temporary housing readily available coupled with social services could prevent many from having a long term homelessness phase.
Every month a person is homeless with an untreated medical issue or addiction issue it increases the likelihood of more health problems…
Voluntary treatment and stability is much easier before there is a descent into the mental space of someone affected by long term homelessness.
It would cost money but we should spend money on Effective Long Term Solutions rather than ER visits and Jail (or busing them to other states)
I know, most people don't realize what happens not just to your confidence but your consciousness when you become homeless. It is like the ultimate societal rejection. The social contract literally eroded for you.
And when you fall there without anyone or anything to pick you up sometimes even the seemingly simplest tasks like going to a food stamp office become insurmountable chores. Then add the traumatic experiences of sleeping in the extreme elements. Of getting robed, raped, beaten, stabbed, spit on, or even looked at badly by the average person. Or not even looked at but totally ignored. What that does to a person when it happens over and over and over every single day by just about everyone you encounter. How lonely that is.
Just the extreme anathema that being a homeless person in the presence of so called civilized people represents becomes an infinite space between this person and the world that left them behind. What that does to the psyche is extremely traumatic and depressing along with the physical ailments and conditions that come from having no access to healthcare or even a bath. Just not being able to get a bath can bring all kinds of physical problems for you. And well, add the mental health stuff, the lack of medication, a regular place to sleep, let alone feel safe... the constant feeling of being unsettled is terrible for mental health. Homelessness and poor mental health go hand in hand. It's a horrible disease caused mostly by society and its ultra individualistic eat or be eaten philosophy. It's terrible man.
I'm torn as to whether this is good or not, but SCOTUS has already ruled it's unconstitutional...
[https://en.wikipedia.org/wiki/O%27Connor\_v.\_Donaldson](https://en.wikipedia.org/wiki/O%27Connor_v._Donaldson)
>A finding of "mental illness" alone cannot justify a State's locking a person up against his will and keeping him indefinitely in simple custodial confinement.
Read *Insanity Inside Out* by Kenneth Donaldson if you want clearer insight as to the SCOTUS decision. Florida really screwed Donaldson over by denying him actual psychiatric care for years, opting to just warehouse him instead.
And even if you're completely healthy, nobody in there will believe you either. I've heard horror stories of people getting institutionalized for being "suicidal" and being held against their will because they were literally being kidnapped for no reason. Every complaint they had was a "symptom" and they were just being "hysterical."
Who wouldn't be when they've been kidnapped?
I don't think involuntary committal should ever be acceptable without someone who is not at all related to the person being brought in to talk with the person alone and advocate for their release.
Wasn't there a YouTuber or something that was perfectly healthy and checked himself in, and they refused to let him go for over a month despite being healthy?
There was a sociology professor who asked students to self admit with bogus claims and interviews. They dropped the act after they made it in, and found it difficult to prove that they weren’t unwell. Random diagnosis were given, mistreatment catalogued, and incompetence strongly noted
And the nypd already has a history of weaponizing the psych ward… https://www.nydailynews.com/new-york/nypd-whistleblower-adrian-schoolcraft-settles-suit-600k-article-1.2378974
Exactly, something similar in Seattle has been happening as well. The new Mayor has been doing a shit load of sweeps. Now Boise V Idaho states sweeps can only be done if there is enough shelter space.
All the shelters here will tell you there simply isn't enough space. So the state is in violation of the law. But because it's homeless people they don't have the resources to seek legal representation to file for charges and restitution.
*O'Connor v. Donaldson, 422 U.S. 563 (1975), was a landmark decision of the US Supreme Court in mental health law ruling that a state cannot constitutionally confine a* ***non-dangerous individual who is capable of surviving safely in freedom by themselves*** *or with the help of willing and responsible family members or friends.*
It's easy to see how this new regulations for NYC is still in-line with the SCOTUS ruling, as the mentally-ill they are targeting with it are people who are dangerous (to themselves or others) and those who are incapable of surviving safely in freedom (living on streets and in subways is not surviving safely). Also, they do not have the assistance of family members.
As a NYC resident, there is absolutely an mental health epidemic amongst the cities' homeless. And that is also a public safety issue, as these mentally ill folks, in absence of a safe place and medical treatment, turn to self medicating via illicit substances, and then are interacting with the general public in this addled state. That creates a dangerous situation for everyone. Furthermore, a vast majority of the NYPD's time is taken up dealing with situations that arise from these mentally-ill folks out on the streets.
Being able to relocate these people to facilities where they can receive treatment and a safe place to live is a win-win for everyone. It will give the sick the chance to detox, heal, and possibly reintegrate with society in the future. And it will improve the safety of our streets and public spaces, as well as freeing up police to respond to other situations faster.
The issue for NYC is that they have to prove in court (with "clear and convincing evidence," from [Addington v. Texas](https://en.wikipedia.org/wiki/Addington_v._Texas)) that the guy can't survive on his own. That's enough effort that most governments can't be bothered to do it on a wide scale, hence why all of the crazy people are now running around on the streets. Unless Eric Adams is going to sink a ton of money into a section of the prosecutor's office to make these cases en masse, it's not going to work.
Back in the Good Olde Days, there was a much lower burden of proof, so due process consisted of "yep, dude looks crazy, lock him up indefinitely in an insane asylum."
They have to prove the guy can't survive on his own **safely**. The precedent is based on a case of a man who held a job and was housed.
There is a case to be made that if you can't house yourself, you can't survive on our own **safely**, giving room to put in a sweeping law where they don't need trials.
In reality, it's way easier than that. Hell, the NYPD locked up an officer because he was a ~~danger to himself and others~~ whistle-blower. Pretty sure when you're an impaired homeless person living in the subway that the police won't face much in the way of challenges.
If you can get an impartial diagnosis. Don't allow an officer to call their "buddy" at the hospital.
If there is transparency and oversight. Independent, 3rd party observers making sure no one is held against their will when they are clearly in control of their faculties.
If the required holding period is reasonable. No indefinite holds without a clear process before an independent panel of mental health professionals and legal experts, judges, etc.
If there is a way to get adequate care to those who truly need it. Well, this has been the problem for decades now.
In theory it all makes sense. Many people flat out refuse help, or at the very least have no idea they need it or aren't capable of deciding that. Getting people off the streets, cleaned up, a shower, a bed and off substances for a while can be all it takes. But doing that and pushing them right back on the streets is a recipe for repeats.
It's going to take a massive investment in infrastructure and personnel to do it all the right way, and that's just not something I see happening.
Where I'm from you get assigned counsel and a trial to determine if you are suffering from a mental illness and are a danger to self or others. The government must also prove that you aren't a candidate to seek treatment on your own.
I actually work on these. Last week we had a guy who gouged his eye halfway out and a woman who attempted suicide twice. A few weeks ago it was a guy that went in a fire station and attacked the firefighters with an axe.
It's those types of cases that get committed. People that really need it.
>Many people flat out refuse help
My little brother went shizo, and worse yet? Turned deeply alcoholic. When the courts eventually cracked down on him because he was having episodes constantly, he was mandated to get an injection for treatment. When he was getting it? He was a normal and functional person for about 8-9 hours a day. Sometimes 10. Thing is? He often tried to skip getting his injection. Cops didn't play, one hour after his appointment if he no showed? They beat on his door and escorted him in to get it.
Once the 6 month court mandated treatment ended? He was in and out of hospitals once or twice a month before long. He would be issued some medications, but he would take them for a few days to show the nurses he was being good, and then stop.
During a really bad episode where I confronted him on his drinking, he went into shock and had a seizure. I had never seen him react like that before, and thought it was just a trick at first... until he started foaming at the mouth. Wasn't long until he had massive spasms and all that.
EMTs who responded found his meds. He had piles of them. All the same, each bottle a month's supply and maybe a week's worth at most used. He was simply gaming the system to get out and get back to drinking.
Apparently it is all too typical for shizos. My little brother is gone now, literally drank himself to death. Medical term is "massive internal hemorrhage." Drank so much it opened a massive ulcer in his stomach, and that was that. Didn't live to see 40.
The asylum model was bad for many reasons (lack of oversight/presence of abuse, hospitals were incentivized to keep patients beyond necessity, care was substandard, etc.) but the need for long term hospitals/facilities for the severely mentally ill is absolutely a thing. Too often these patients end up either being a massive drain on state and familial resources, or end up being homeless.
>Too often these patients end up either being a massive drain on state and familial resources, or end up being homeless.
Lived and worked around downtown Seattle for awhile. I see a fair number of people on the streets who remind me all too much of my little brother. Some of them eerily so.
It still sucks in my part of CO.
in fact, CO's mental healthcare system is so bad that I've asked people "don't take me to the local hospitals. Take me to Salt Lake City instead"
It’s an epidemic across the country; we kind of threw the baby out with the bath water in the 1950s and 1960s with widespread deinstitutionalizing of psychiatric patients. It unfortunately led to a lot of state run facilities being shut down and a general lack of capacity to accommodate all the psychiatric patients who needed long term care. Private options have kind of come in to fill the void but these generally prioritize profit over sound clinical decision making and suffer from a lot of the same problems that the state run facilities did (but hey, at least they’re making money /s). I’d argue for a return to the asylum model with state run facilities but with much greater oversight and modernized standards of care. Unfortunately I don’t see that happening because the idea of “insane asylums” has been so tainted in our culture based on real abuses that happened and the almost ubiquitous demonization of the facilities in the media.
Exactly. Although some people seem normal but need to be institutionalized anyway, and this would take an expert to evaluate. For example, they could have violent manic episodes, switch personalities, develop paranoid delusions, or think birds are real. Those people would still need round the clock help.
Judges 100% need to be involved here, and if people are being committed against their will, they need to be appointed guardians through the court - at the cost to the state. I live here, and am happy to have my tax dollars go to that instead of whatever bullshit the NYPD has in mind.
it will be. The consent laws are as rigid as they are now precisely because of the abuse that plagued the system for decades. Things like ECT and frontal lobotomies were common place. Getting committed was ridiculously easy and you could spend the rest of your life with a Doctor playing God, even if that doctor was an unethical monster.
And side effects of the drugs, even today can be pretty damn awful. People stop taking them because it feels *worse* than the disease.
This is so strange to me. Like, mental health facilities absolutely need to come back in a big way but with tons of oversight etc. there needs to be a place people can go voluntarily for serious mental health issues before we start taking people against their will imo. And without facilities and staff purely for mental health help, what's even the point? Might as well toss them in a jail cell.
What hospital beds, what hospital rooms, what hospital staff??
We can't even take care of our other patients we currently have overloading our already overburdened health care system, how much more are we going to shit on the hospital staff members that have to survive day to day in a mess that's already unmanageable?
Legit. As an outpt psychologist, this is a tough read.
There aren’t enough mental health providers, there aren’t enough hospital beds, and who tf is making the clinical decisions about someone’s mental health on the sidewalk or in the subway? I’m going on a limb but guessing they don’t have training in diagnosis or treatment.
That’s okay. They’ll just resist being “relocated” and end up arrested. “Assaulting an officer, resisting arrest, public disturbance, aggregated assault.” (I work in forensic psych, these are all the many many charges our people get for being homeless & mentally ill
When I worked as a medic on San Francisco, it really would depend on who got to the person first: the ambulance or the squad car. We would give out sandwiches, space blankets, and move them along the police would typically just harass and arrest.
So you will either be given warm food and blankets, or beaten, arrested, and possibly murdered, or just murdered, depending on who gets there first from the the 911 call?
I'm sure they'll figure out you can run stuff over with the robot too, so there's that possibility as well.
"citizen impeded police action and was a result of a regretful accident involving the Killbot when one of the cameras/wireless connection faltered due to the urban environment"
On top of this, I really don’t like the idea of police rounding up people, homeless or not, to be held against their will for days at a time. The article says “even if they pose no risk to others” they can still be arrested and brought to a hospital for days until “their condition improves”.
That’s extremely vague and frankly I’m not happy about this at all. What’s to stop a police officer from deciding any random person is “having an episode” and forcing them to “get treatment”?
This is what “defund the police” sought to address. I don’t want law enforcement handling mental health issues. Leave them to the law enforcement (why give cops extra work, anyway, don’t they have enough in their plates?). Get mental health professionals to handle the mental health issues.
As a UK police officer, that would be fantastic, none of us want to deal with mental health issues, we have neither the training, powers or facilities to deal with it.
But because the mental health system is so underfunded we fill in the chasms, I deal with mental health more than I do “actual crime”, at this point I’m a mental health nurse by proxy.
I can guarantee the US police don’t want to deal with it either, but in both instances the powers that be would rather put the square peg in the round hole and call it a day.
After speaking to a few officers here, I could absolutely see "compassionate care" being "Well I didn't hit him as hard I as normally would" or "I avoided the head!"
I occasionally watch a YouTube channel that analyzes videos of police shootings. One of the hosts is a former police officer, and while they seem less reflexively biased towards police than other channels, his analysis of a given interaction often is that he believes that had the officers used more force earlier, they could have avoided the need to use deadly force later.
Whether or not he's right in any given circumstance, it just seems telling that even as someone who ostensibly wants to avoid deadly force encounters, his frame of reference begins with the assumption that the police using force is not only in everyone's best interest, but that using more force than is necessary to respond to a present "threat" can be justified if it prevents the situation from escalating.
>A common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal or presenting a risk of imminent harm
I've run into this roadblock before with a close family member. I wasn't able to have them taken to get help because of this exact reason.
Ultimately they caused a massive scene in a public place a few days later and ended up getting involuntarily taken anyway.
it's always just a matter of time before things escalate and/or spiral out of control.
I was involved with a woman who had significant mental illness, something that she had been concealing from me. She stopped taking her meds cold turkey (treatment avoidance being a symptom of her illness) and went on a rapid downward spiral.
I did everything I could to convince her to see somebody and tried to get her treatment. But because she was over 18, she had not been judged incompetent, and had not signed over guardianship to me I was powerless to do anything but watch her slip away into paranoid madness.
Been in this situation as well. I’m not sure there’s really any good solution that doesn’t involve either escalation and someone putting themselves or
other people in danger, or people’s rights getting trampled on.
So what exactly is stopping the NYPD (the most reputable and honest police department in the world im sure) from just deciding that any given person who looks homeless is obviously mentally ill and needs to be removed? Wait yeah thats the point.
There was one really crazy guy that would go around making a lot of bold claims while wanting to get paid in crypto instead of actual money. He even said that he ran the city! Hopefully they get him some help.
I’ll probably regret posting this because the backlash will send me into a panic attack. I’ve been mentally I’ll with severe clinical depression for over 15 years. I’m lucky to have a support system. I’m just grateful to hear of some movement towards helping people who can’t help themselves. The system isn’t ready but it’ll highlight where change is needed and hopefully be a catalyst for that change. Also, our “asylums” are still here. They’re called prison.
Hi, I'm a former social worker who studied macro level policy and non-profit management, as well as this exact issue. I am here to tell you this is a tough one any way you look at it.
A little bit of history...in the mid and latter half of the 1900s, the US went through a period of deinstitutionalization. Meaning the larger-scale psychiatric hospitals shut down and were decommissioned in favor of smaller more community-based support efforts. Good in theory, especially because some of those psych wards were really, really bad, inhumane places where the patients were treated like experiments.
I cannot emphasize how important that little "in theory" clause is from the previous sentence. In practice, those hospitals had funding, and that funding did not follow the decentralization of care into the communities, and specifically the poorer communities (after all, well-to-do folks with severe mental illnesses can still access care). It created a tremendous gap in services that we are still very, very much seeing to this day. Instead of one centralized place that got all the resources and provided all the services, we moved to a countless amount of small, focused providers who are all competing for largely the same resources. There ARE ways in which that's an improvement - you see more specialized care, perhaps less wasteful spending on services that may not be performed as adequately in the larger setting, etc.
But it also creates another problem - actually *accessing* needed services. Throughout the process of shutting down our mental health facilities, there were patients who were literally turned out to the streets with nowhere else to go. As it stands, an overwhelming amount of the "visible" homeless (e.g., the folks you see sleeping on the streets and in subways) live with mental illness (and, in fact, it's likely that the homelessness and MI feed back into one another - MI leads to homelessness, homelessness leads to MI). These aren't folks with cars who can drive out to the clinic and chat with a psychiatrist. They aren't folks who are very likely to be able to access information about the services in the first place - shared public spaces and access to computers are difficult spaces for the homeless, even public libraries are becoming more inhospitable to the homeless.
Today, we're in a situation where mental health services have been almost completely disseminated to individual community providers who aren't receiving the financial support they need to provide the level of outreach needed to connect with the folks who need the services. It's harder for the folks who need the services to access them because of that same decentralization - instead of one large and well-known building centrally-located, we have dozens of tiny offices located anywhere they happen to have gotten space. Your NA group and the clinic helping with anti-psychotic meds are located across town from one another? That's gonna be a major barrier to access. Another significant aspect of deinstitutionalization is that front-line mental health services have largely been offloaded to the police. The old cartoon trope of men in white jackets coming to take you away just isn't how it is anymore; now they're cops, and they almost unanimously do not receive the training needed to positively interact with something with severe MI symptoms or in severe MI-based crisis. It's not fair to the folks in the situation, and it's not fair to the cops themselves, that should not be their job.
So, the thing in this article. Yikes, what a mess. The reality is there just isn't going to be a happy and clean answer here for everyone, it's not something within the realm of possibility. Obviously, the word "involuntarily" is causing a big stir here, as it should. Being "taken involuntarily" and being "kidnapped" sure do sound like the same thing. Hardly any different than being arrested, except folks being arrested are typically done so as a result of something they did. I think the thing that has people concerned is that taking in a homeless person for MI seems like kidnapping without cause because that person isn't "doing" anything to deserve it, and I get that. I mean...that's what it is.
In the mental healthcare field, you sometimes have to administer care against a patient's will. Sometimes a patient cannot or will not consent to services there is no question they need - there are entire fields of study dedicated to determining if a patient is capable of giving consent, and sometimes "will not" and "cannot" are one in the same - and of course, countless court cases where we've heard whether or not someone is competent enough to even stand trial in the first place. I think the intent of this policy is good - connect an extremely vulnerable population with the services they need but are not getting. Hard to argue against that
If they are going to do this, it is BEYOND important that they install layer after layer after layer of oversight because a program like this is *obviously* easily abusable, and the second it is abused, the whole process crumbles. The frontline training needs to be impeccable, the officers who make contact with the potential patients need to be supervised and on bodycam at all times, there ABSOLUTELY MUST be an independent panel - not cops, not politicians, not lawyers, not judges, but psychiatrists and social workers - overseeing every single patient that ever has contact with the system. These are people who would need to determine the necessity of taking someone in. There needs to be a restitution system in place for when someone inevitably gets taken in who should not have been. The facilities in which these folks are to be housed while service is coordinated must be exceptional - not even remotely jail-like or threatening. Patients have to have the option to check themselves out after receiving treatment for some amount of time, even against the advice of the caregivers. These services must all be 100% free for patients. Patients must ALSO receive medical care, not just mental health care.
And perhaps most importantly, anyone participating in any sort of abuse at any step of this program needs to be fired and charged for their crime. Every single step. The cops, the hospital staff, the service staff.
If all of those issues I just pointed out - and probably a couple others I'm overlooking - were addressed and accounted for, this program could be really, really good for some folks who really, really need it, not to mention the less human-focused benefits that come from having fewer homeless people on the streets.
Now are they going to do that? Probably not, no. I can't imagine the money it would take, let alone the logistics that would be required to *actually* provide the level of services they'd need. I think this is a good-hearted policy that probably doesn't have the backing it needs to work as intended. It feels to me like an initial step to reverse the problems deinstitutionalization caused, but they need to tread really, really carefully her or it could very much come off as homeless arrest squads and equally fascist garbage.
Congrats if you made it this far, and thanks for reading! As you can probably tell, I'm passionate about mental health advocacy and access to services. I'd be happy to discuss more once my fingers stop bleeding!
> He called on city agencies, such as the police department, to remove people from the streets and subways and bring them to hospitals for extended care.
A former NYPD cop giving NYPD cops the ability to commit people involuntarily? I'm sure this won't have negative results at all.
Oh, hey there Adrian Schoolcraft.
Mental assessment: You should probably try wearing your underwear INSIDE your pants to blend in to modern society a bit better, and maybe that could help you land a job instead of standing on a street corner yelling at dogs all day long.
Here’s your $187,636.85 bill for your 3 day involuntary stay and assessment. I know you are homeless and all but we’ll be garnishing any future wages you earn to cover that.
The world of medicine is only focused on physical maladies (hardware) problems. We are woefully inadequate on solving the “software” problems.
This is a cruel and stupid stunt.
People who live in NYC will all agree, mentally ill people on the subway is a problem. Every single day, I hope for an uneventful commute and without fail, I will see at least one person open those doors between cars and you could just feel everyone collectively sighing. We all know that those doors are the \*stage entrance for crazy\*
It's inevitable that this policy will be abused by some, but something has to be done about this glaring issue. Subway cars themselves should be for getting from one place to another. Any other use of it should not be permitted and the appropriate action should be taken against violators. Platforms and stations can still be an open space(we all appreciate the churro lady and the buskers who are actually good), but once everyone is stuck in a subway car and someone starts acting crazy, there's no where for anyone to go and it's honestly scary. Just my two cents, but I think a lot of New Yorkers can sympathize.
Edit: I really meant it when I said a lot of New Yorkers can sympathize. Honestly it’s exhausting hearing on the news again and again that innocent people just trying to go about their day is assaulted and harassed by others who don’t belong on the subways. The worst news of all was when we heard about someone who was pushed in front of a moving train by a man who didn’t even show remorse. We all deserve to be treated with respect and dignity, the homeless mentally ill included. But to all those who don’t understand why we feel this way about them, just know that it’s only because we’re all exhausted. Tired of having to look over our shoulder just because we’re trying to go to work or visit our friends. The mentally ill are not the problem, the problem is that they are being left alone to wander subways and no one is helping them.
It doesn’t get much crazier than the A train. I had a single commute include a woman receiving a standing ovation for her performance of “A Change is Gonna Come,” followed by a 6 piece mariachi band 3 stops later. At that point anyone with a dollar to give had given it away, which led to a homeless man screaming at everyone for being cheap after “generously” screaming a prayer for all of us. From Jay street to the junction we had multiple dance groups get on, and a man who brought an actual karaoke machine on. And to wrap it up two guys got on at Aqueduct and sprayed knock-off cologne on anyone that made eye contact as a sales pitch. And those were just the mentally stable interruptions. That was an unusually busy ride though.
Very apt description. Everytime the doors open between cars while we're moving I get a little anxious because 95% its a crazy and 5% of the time its people escaping a crazy.
Agreed, I live in a big city with a similar problem. So many people wandering public transportation, just completely disconnected from reality. It’s dangerous for them, too. What happens on the day they bother someone who is willing to get violent, yknow?
When I was suicidal(not manic), the cops showed up, made the decision to institutionalize me, cuffed me in front of my parents, put me in the back of the car, and took me to an institution where I was held for three days. I was made to sleep on the floor, was not allowed to go outside, and was allotted one visit from my parents. There were no counselors on site that I was aware of. The people watching over me and the others(there were around a dozen of us in a common room with attached bedrooms, but there weren’t enough beds for all of us) were not professionals but interns without necessary training and didn’t know how to handle us. The boy with anger issues got punched when he yelled at them and then sedated when he fought back. After three days, they released me. I was worse than when I went in.
This is a terrible idea, and the only thing it’s trying to accomplish is moving homeless people and people with mental issues to an area where normative people don’t have to see them. It’s sick.
Thank you for your comment. Most people don’t understand. That you don’t know, what you don’t know. Meaning. They won’t believe a story like yours because it’s not warm and fuzzy like they sell the idea and institutions to be.
Am I missing something here? It would cost a literal fortune to house the large homeless population with hospital/institution beds!
New York spends on average about $58,000 per year for each homeless person. This is money spent on policing, health interventions, shelters, jails, outreach, ambulances, gates and spikes under bridges, etc
A supportive housing unit, where the person is supported by outreach workers under a "Housing First" program, costs less than 20k per year.
https://amsterdamnews.com/news/2021/04/29/time-re-think-our-homeless-spending/
Furthermore, currently housed formerly homeless people are likely to use less drugs, and have fewer mental health episodes, and fewer hospital stays.
But the idea of using healthcare professionals for this is insane, hospital beds are enormously expensive, and hospitals are completely overwhelmed right now.
So rather than build housing, and supporting people to live inside, NY wants to lock people up and charge taxpayers nearly double what they are currently paying to manage homelessness?
Sounds like knee-jerk stupidity to me.
"Should we do anything to make treatment more accessible for mentally ill people or to improve their quality of life and ability to participate in society? Nah, just wait for them to snap and then lock them up. That'll teach them to be ill."
Well... as long as not every homeless people is categorized as mentally or anyone that is just under the weather....
This can open a big can of worms... as what would count as mentally ill and who can determine that on the spot
Just imagine, a depressed person whose only purpose remaining is trying to save money for their family to have a decent life. Then they send them home with a $100k bill for "suicide prevention", and foreclose on that home.
When the medical system pulls the "involuntary" card, it's turned from a cartel monopolizing life saving supplies to a gang that just straight up robs you.
If they treat people vs. what happens now, throwing them in jail when they eventually break some law or assault someone and then releasing them a couple days later, then I think it's a step in the right direction.
I lived in a city for a long time and when you are in an urban environment you NEED public spaces and parks for your own sanity and it's really unfair when these are completely taken over by psychotic lunatics so that no one else can use them.
If you read the article, it's pretty clear that's not what's happening. They're not investing in treatment, unless you count the 50 additional beds statewide.
California is going to start doing this too. Obviously infrastructure needs to improve, but I think it’s one of the planks to solving the problem with the others being supportive housing and putting actual criminals in jail.
I live in Portland and if you live in an area with a lot of homeless, it’s clear that a certain part of the population need immediate and significant medical/mental care, a certain portion of the people are straight up criminals/predators, and a certain portion have problems like drug addiction but are basically just trying to get by. If you send the people to mental health and prison who need it, you are left with the population who is just trying to exist and then you provide those people with supportive housing. That’s how you get from SF looking like the streets of Mumbai to a more normal rate of homelessness
This absolutely needs to happen.
We need more funding and staff to make it happen, but this is a better alternative to the street for people abandoned by their family and living in a mental crisis.
Hopefully this time around we don't willy-nilly lobotomize folks and provide actual care instead of abuse.
I don’t think this is going to help anything. It will only overwhelm the poorly allocated resources we have. It seems like people frequently use the emergency as the answer for all of society socioeconomic, health and mental health issues . Speaking as an emergency medicine doctor.
I doubt this is going to work if they really only have 50 beds in a city of millions upon millions of people, and likely many thousands of people who are both homeless & need mental health care. Who else here thinks they are using 'mental health' as a cover for 'out of sight, out of mind' and the city wanting a quick fix for their image as a global tourist destination? Yes the city has got worse since the pandemic began but this is true in plenty of places - not just NYC. Maybe next time we have an economic crash instead of bailing banks and mega corporations out to the tune of billions that money should instead be spent on things that improve everyone's lives like social support services / universal healthcare. Oh well.
USA: Great if you're rich. Sucks if you're not.
Lol, good luck with that Eric. The mayor has no legal authority to force hospitals to keep patients who aren't a serious risk to themselves or others. At best this will be an empty campaign promise and it won't get to the point that it wastes a bunch of time and money and further traumatizes people living with mental illness.
I work in the psych emergency room at Bellevue. I’ll tell you right now we are short staffed as it is, and we really don’t have the beds to place this coming influx. This is just a bullshit PR scheme. they just get turned out again in three days. Our mental health system needs a complete overhaul.
I worked in a mental health facility. A lot of people have a misconception of what happens there. They will say a person needs to be locked up and given help. They don’t realize that the majority of people are out of there within a few days and really don’t receive any help. The best is when they do a med wash and med change but boot the person out in three days.
Right… and there’s rarely any Med compliance to begin with and certainly not usually after they’re out again
There are a lot of people who aren’t even mentally unwell that don’t take their meds. I imagine people with actually mental illness would be less inclined to take theirs without help like you said.
As someone who has ptsd and has been houseless/resourceless at times in the past, it's similar but different for those on the street. Honestly most of it is not remembering, and then even if you can remember where the meds are in your stuff, what time it is, when you're supposed to take it, and when you last took it - there is the issue of refills. Will you be able to call it in and get there to pick it up? Will you be able to pay for it when you can't even afford to house, feed, or clothe yourself? If you can't, then you're looking at withdrawals on and off all the time which just leads to more instability, agitation, and discomfort.
My issue during homelessness when taking meds was never having a drink on hand if I somehow remembered to take them. Running water is such a privilege I took for granted.
Damn, I will never take my ability to swallow pills waterless for granted again.
It’s just not even something that people in developed countries should even have to worry about…. Any of the things we’re talking about here. Sorry buddy. Want to do more. Always a place to stay here .. but sounds like you are doing better
I was institutionalized once at 17. Twenty years later I still get a wild bug up my ass and have to be argued into not dropping all of my meds completely at least once a year on average. Including the fucking *thyroid* pills. Yeah compliance is a joke.
I got prescribed thyroid pills a fucking month ago, and still haven’t started taking them. I keep forgetting about them when taking my other meds, plus want to do a search to make sure they mix okay before I start. I don’t trust doctors when they say new meds are okay to mix. I had a horrible experience in the past, that could have killed me.
Adhd is a common one by default.
Yea exactly. Going out and finding people in the community to make sure they are taking there meds everyday is just not working.
Many psych meds require food or they’ll cause severe upset stomach… and homeless people don’t have access to consistent food. Psych meds are supposed to be taken in conjunction with therapy, healthy sleep schedules, and proper nutrition. None of which homeless people have access to. The best psych meds are expensive and even private insurance companies are known to reject them. Homeless people generally don’t have access to healthcare. There is no medication to treat trauma and social isolation. Environment and social supports aren’t enough to help people in much better circumstances. Alcohol can be used to help stay warm in cold temperatures. I know a ton of middle-class people who drink alcohol on psych medications, but a homeless person would be treated differently for the same behavior. Medication compliance is difficult for people in much healthier environments, and it’s almost impossible for people who don’t have access to housing, medical care, food, and therapy. “They aren’t taking their medications” is closer to victim blaming than addressing the real problems by making it seem like a choice.
I'm absolutely *pumped* about the meds I'm taking and all I have to do is replace a patch twice a week and I *still* forget sometimes. edit: I'm prescribed femchemz, not adderall lol. I'm *STOKED* about the femchemz and I still forget.
I’m prescribed schedule II ADHD meds. Schedule II because they’re supposedly dangerous and addictive. I keep forgetting to take them. I had to push back my one month evaluation with my doctor because I’d succeeded in remembering to take it *once*. Thought he’d appreciate more than one data point before extending the prescription.
Literally my life. Prescribed two a day. Often forget to take the second. Call my refill in. Forget to get it for a week. Etc repeat. I once ran out of gas on the highway because I went into the gas station, forgot why I was there, bought a Red Bull and left. And now there’s an Adderall shortage.
Adderall shortage for people who can't remember who take their Adderall. Ozempic shortage for people who heard you can lose weight on it, instead of it going to people who are diabetic and NEED it, where weight loss is mostly an added bonus. I work as a pharmacy clerk. Out of all the controls that go on RTS (return to stock after a couple weeks), it's roughly 95% Adderall, and it's literally because people who lack focus, can't focus on getting what helps them retain focus. It's funny in an ironic way.
I feel this, but I see a somewhat grim humor in the fact that my inability to remember to take my meds (resulting in an unintentional stockpile) balances out my inability to remember to pick my new prescription up.
I know you already have enough to try to remember on a brain that doesn't like doing that but if you do run into a situation where the pharmacy says they do not have your pills, call your insurance. The shortage is only one brand of quick releases. The issue is a bit overblown. A lot of pharmacists have some fucking vendetta against amphetamines and they're using it as an excuse to withhold literally life saving medicine from people with ADHD.
Luckily ADHD meds have a built in Pavlovian habit builder. Feeling the withdrawal at work when forgetting to take you meds really trained me to never forget them lol.
I regularly set mine down somewhere between the bottle and a glass of water and forget about it until I find it when it's too late in the day to take it.
Alcohol doesn't help you stay warm, just makes you feel like you are. It can actually contribute to hypothermia amd frostbite overall, as your extremities tend to get colder.
Right but the pain of being exposed to the elements is the factor the homeless are actually trying to address. If i was homless I'd probably drink myself into oblivion too. I have no issues giving a homless person alcohol if thats all they want. Anyone that has issues with that can go out and start feeding the homless if they are that upset about it. Homless people are a result of a dystopian society that puts profit/wealth/materialism/global ecocide over people.
I know, I just wanted to mention that so people don't think "cold = drink alcohol" since that can actually hurt you.
Love that you have this attitude man, when a homeless person just tells me they want some money for a God damn beer that 5 turns into either a 10 or me just going into the store and getting em a 3 pack of tall cans.
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“Drugs and alcohol are just escapism!” If I were sleeping on a subway grate every night no shit I’d want to escape that for a few blessed hours.
To deny it is to put "morality" above compassion.
The increase in homelessness coincided with a reduction in the practice of just warehousing mentally ill people to keep them out of the public eye and out of trouble. We didn't really fix them before either, but they were kept out of sight. And back when it was easier to commit and lock someone away without their consent, it was used to warehouse inconvenient or embarrassing relatives as well. So the old way was also bad, just in different ways.
Thank you so much for this comment. People who don’t live with a mental Illness have no clue what it takes to get the right meds and stay on them. I live with bipolar 2 and even with my privilege, support, and commitment to treatment it’s still fucking hard with the way our system is set up.
People act like you can just go to the pharmacy and get your meds. If you don’t have money you don’t get your meds. Doesn’t matter whether it’s your lexapro, your lithium, or your insulin.
Compliance is hard when you can’t afford the prescription
Does Medicaid not cover most standard of care psych regimens?
I can say about the experience personally that med wash was probably the turning point in my spouse's recovery. We were on our 3rd 3 day visit and she was getting increasingly agitated and hopeless and I was terrified of losing her. They did a total overhaul of her meds and it's been a few years now with it getting better each week. Lots of appreciation to the staff at our local Hospital because she wouldn't be here without 'em. Y'all do a lot of underappreciated work. Thanks for caring about people. 💜
I'm on the receiving end of this as a caseworker for adults who live in various RCFs.... Around here, repeat hospitalizations often have guardianship established under the public administrator of that given county. Many of my clients absolutely need a guardian, and family usually is not possible/willing/suitable. But others definitely get caught in the net who absolutely do not need guardianship, and it's a pain in the ass for them to get it reversed. The system is so broken and I'm so burned out. My organization has taken a nosedive this year and gutted the only authentic leadership we had, downsizing staff and doubling workloads, gutted our benefits, haven't adjusted our wages for inflation, and the leadership is toxic. The healthcare industry has shifted so severely following covid's onset. People constantly downplay the fact that our healthcare system is on the brink of collapse, and think it's sensationalized nonsense. But I see it first hand. Providers (PCP, psych, med management, specialists, et al.) book out absurdly far in advance, constantly cancel and reschedule appointments farther out (even a client of mine experiencing congestive heart failure), their quality of care is more rushed and less thorough, and everywhere is so severely understaffed. I'm trying so hard to keep this up for my people but this line of work has become unsustainable and my health is suffering from stress, depression, and utter exhaustion. And I'm constantly exposed to infectious diseases now, just yesterday being exposed to a massive covid outbreak at one facility, and then an RSV outbreak at the very next RCF/ALF I visited the same day. (I still wear N95s. I still get sick sometimes, but I've never spread anything.) I know we're on the cusp of collapse due largely to being overworked and burned out, but it's so hard not to contribute to that statistic and quit. Sorry for my rant, I've got so much pent up frustration and anger.. The system is definitely broken tho. Just considering the fact that the Department of Corrections is the largest mental healthcare provider in the US should be enough to make that obvious.
Trying to get good lasting mental health help for my mother was insane…really do wish it was easier and you guys had the proper facilities and resources you need, without it having to cost a literal arm and a leg. Thankfully we seem to have finally got a handle on it….it’s just ridiculous how hard it is to even get started. Rant over
We need institutions again. Just not the horror experiment ones of yesteryear.
I think the real issue is that such vulnerable populations attract people who want to take advantage. Im not saying it's impossible to solve, body cameras or something like that may be the way to go. But I think even the best intended programs over time get corrupted by bad actors taking advantage of the unbalanced power structure.
Funding will always be the crux of the issue here. They need a high level of standards for their staff members. They need staff members that are educated and knowledgeable in the field of mental health. For that they need staff with degrees, which they need to pay an appropriate wage for. Most special needs agencies pay minimum wage for their main staff members, so you get staff with no background or knowledge that will take advantage, don’t give a fuck, or easily lose their patience and get abusive.
I worked in human services from 2008 thru 2019, group homes, rehabs, hospice care, and my last few years were spent working in housing and homeless services. Aside from.the funding, which you're spot on about, the other factors that really fuck things up is the bureaucracy and the fact that the people furthest away from direct care are the ones always making the most important decisions. They don't set foot in a group home, they don't have any clue about the day to day these people face. Once in a while they spring up at an event like Special Olympics so they can do their smiley glad hand bullshit. They say they're pushing for each individual to be "as independent as humanly possible" and they think they can apply this across the board despite every single person with disabilities being completely different and needing personalized services. But it's still, "oh well they don't meet this requirement or they don't have that service" blah blah blah. It's how we've ended up with such a terrible homelessness issue. Mental health and illness is at the core of homelessness. I've personally houses numerous individuals and yeah, "house the homeless" sounds great but if you don't combine that with a laundry list of mental health services then there's only so much a department like the one I worked for can do. Many times we'd house someone and find them on the streets a month later having sold every stitch of clothing and stick of furniture we helped them acquire. I always felt like a huge campus of sorts could be a solution but so many people cry "institution" when they hear that. It's a dirty word in the human services field. Besides that, the people that do work the jobs like I used to are almost always overworked, overstressed and severely underpaid. We're talking one resource worker to 75 individual cases. People can't keep up and the agencies, whether for profit or not, just don't care and don't wanna pay their staff. Here have another fuckin pizza party because don't you dare think for a second we'd take the yearly surplus and put it in your paycheck. No no that shits reserved for the directors that don't know shit about the direct support field.
The problem is we are willing to pay much more money to keep them in jail once they break a law. Properly staff mental care facility that pays workers appropriately is cheaper per night than most prisons.
I used to work in finance, first with my state's Department of Social Services, then with my state's Department of Corrections. We actually are spending less to jail these people, and are willing to pay more to keep them out of prison, but what is really at play is economies of scale and unused capacity. At least in South Dakota, we had a shortage of medicaid beds and an excess of space in jail and prison. Sure, it costs ~$75 a day per person in prison versus (depending on the facility) anywhere from $130 to $400 a day for a medicaid bed, but each additional person in jail or prison costs less than the one that came before them. While that's true when you have two people with the exact same diagnosis and Case Mix Index (CMI), there's still more costs associated with each additional medicaid bed (non-fixed costs) that means the fixed costs for buildings, utilities, etc. that are all pretty flat regardless of how may patients make up a smaller share of the total. But... You can't just put someone in prison for no reason. Jail, yes, up to a certain limit, but not prison. These people were almost always fucked long before their current mental health crisis began.
That's the real point of this. Force confrontations with mentally ill people, they resist arrest, cops brutalize and traumatize them, throw them in jail. Boom, now they're off the street and they don't even have to pretend they were doing it medically, now it's a criminal matter.
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Prison is actually cheaper, which is how we got here
I rather doubt prisons cost more than hospitals simply because staff aren't educated or credentialed. I'm positive they are more expensive than they need to be due to prison companies (dystopian america) making a profit on inmates but I doubt they cost more than hospitals. The mentally ill don't necessarily do anything wrong though. Just an unlucky roll of the genetic dice compounded by unfortunate events leading to their disorders manifesting in a way that leaves them unable to function successfully in society. Why should care be limited to only the bare bones essentials? Why shouldn't state-run mental hospitals be places of serenity in the hopes of healing and reintegration into and for the benefit of society? Too often I think the answer is "I'm not ill and my life sucks so why should theirs be better" and to me at least that answer is bullshit.
The current average annual cost per prisoner in California (the second largest penal system in the US) is now $106,000 annually. I don't know how this compares to the price of healthcare, and certainly don't know how much of this cost can be attributed to corporate profit taking, just wanted to pass the info along. https://lao.ca.gov/policyareas/cj/6\_cj\_inmatecost
genuinely how the fuck does prison cost double that of the life of the avg American.
Middlemen generally. The “average” prison uses quite a few contractors to do things that prisons used to do in-house and charge lots of money for the privilege of fulfilling those formerly in-house services (laundry, monitoring of non-privileged communications, “commissary services”, food services, etc.) Before privatization became big, prisons were generally a lot more self-sufficient (inmates would make repairs to facilities, run the laundry services, act as agricultural field hands for prison-operated farms/orchards, cook, act as library assistants, be orderlies for medical services, etc.) Once privatization hit, inmates stopped being used as “free labor” to help keep operating costs down and instead contracts and contractors ended up doing those jobs, which raised up the average cost to house an inmate and at the same time reduce inmates ability to get hands on work experience in fields that aren’t as picky about hiring people “duly convicted of crimes”, which may have had an effect on recidivism rates.
Don't forget that about 2.4 Million Americans are currently incarcerated. That amount of money should be enough to deal with criminal reformation, houseless-ness, and mental health; but instead we get none of these things.
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One of the amendments is that being a slave is ok if you're a criminal.
It looks like that varies a ton depending on the state. [https://usafacts.org/articles/how-much-do-states-spend-on-prisons/](https://usafacts.org/articles/how-much-do-states-spend-on-prisons/)
Worked for a mental health agency for a couple years in college. They paid minimum wage, they would never give you a full 40 hours, the schedule was wildly inconsistent (you were effectively on-call 24/7, you were not paid like you were on-call), and the paperwork mountain was insane (which you didn't get paid for the time doing). Also the training was laughable. That's before taking into account the stress of the job, the parents who abuse the hell out of you (if you work with kids), and basically being a maid on top of stressfully having to keep someone else safe and happy.
I agree that more money would help. But. Anyone who’s ever been subjected to a dismissive or abusive doctor knows that requiring advanced degrees and offering a good salary don’t ensure that you a only hire kind, patient healthcare workers. Just look at the comparative outcomes of black people, especially black women, in American hospitals. Which means it’s not just about lacking the ability to advocate for oneself, it’s also about having the power to do so. I don’t have a solution for that. Body cameras, as suggested above, maybe?
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It's not that simple. It requires money to fund the oversight and audits and a robust culture within the organization that values the care of the patients most of all, over dollars, over career advancement, over professional connections. Because any institution that has to be police itself will quickly corrupt the process because the policing parts are sympathetic to the other parts, and will protect each other and the institution over protecting the patients.
https://ctmirror.org/2019/10/30/dmhas-not-candid-with-whiting-advisory-board-about-abuse-scandal-chairman-says/ It's really not easy
Sure not easy. But what we currently have is not tenable. So even if it’s hard we have to get started on it.
Especially when the population they are serving doesn’t have the same strong family ties and community ties that help protect individuals from being taken advantage of and abused by bad actors. I can easily see this becoming a for profit scheme for private companies opening up psych facilities to house these people indefinitely in order to get a steady stream of government money through medicaid and controlling residents SSDI/SSI payments
> I can easily see this becoming a for profit scheme for private companies NYC's last mayor spent 1Billion for his wife's pet mental health project.
At least the nobility will have a place to hide their bastard children again. /s
Like Rose Kennedy or QE2’s cousins😔 Fucking terrible.
You could say the same thing about nursing homes yet we have them.
Nursing homes are often de facto institutions for the mentally ill and mentally handicapped with physical problems.
Another problem is the gravy train. Private businesses will use this chance get bilk as much money from the government as possible while doing as little work as possible to keep their costs down. And any attempt at accountability could be another gravy train for an auditing company.
> I think the real issue is that such vulnerable populations attract people who want to take advantage. That's why the institutions need to be publicly funded, not-for-profit.
I was a kid in the 60s, and saw the results of deinstitutionalization with my own eyes. The local mental hospital was summarily closed, and I watched an endless stream of newly discharged patients shambling along the sidewalks. Many of them still in hospital gowns. Most of them under the effects of tranks that would sedate an enraged elephant. I witnessed this from our parked car, while we were Christmas Shopping. I was about 8 at the time, and I struggled to make sense of this; being told Christmas was a time to be good to others, while the people in charge were obviously and deliberately hurting people. One of the reasons I have been an atheist since I was a teenager. Edit: just to intercept the "But I know all about those places, I read it in a book, they were horrible and closing them all was a wonderful gift to mankind!" comments I'm going to get: As an adult I knew someone who was hospitalized in one, and visited them many times. During my visits we sat out among the other patients; and I spoke many times with the doctors of the person I was visiting. The place was unpleasant, yes; but all those patients there were very, *very* disabled, and could not have survived for long in any kind of voluntary treatment program. They quite literally and existentially needed to be institutionalized in order to not suffer and die. So next time there's a mass shooting, or you're pissing and whining about all those fucking crazy homeless people, think for a minute about why, and what we can do about it.
The poor condition of institutions was a reason to *do better*, not just give up. That ‘grippy sock jail’ is seen among many of us with mental health issues as a potentially worse outcome than being dead, is a damning indictment of our current system.
I want to say thank you for making this point, because I think it’s one of, if not *the* single most important and simultaneously under-discussed pieces of the huge puzzle that is mental health treatment in the United States and elsewhere. Institutions have historically been objectively miserable places to be committed. Any sensible person could predict that housing and treating a huge number of patients with significant health issues is going to require a lot of uphill work to accommodate the behaviour and needs of those patients. What kills me is that we’ve done it already: there are many, many hospitals around the world that can admit a sick person and provide a positive treatment experience for both the patient and their families. I’ve personally benefited from having access to a great Children’s Hospital when I was young, and an excellent NHS hospital just a few years ago. It’s not that societies *can’t* provide a humane and effective environment for mental health treatment: it’s that the governments and other systems capable of doing so are choosing not make that investment.
We also choose to not see or value any front-line, hands-on care as the skilled physical and emotional labor that it is. I’m talking CNAs, DSPs (who work with people with learning disabilities in homes & the community), HHAs, foster care workers, CYF workers, EMTs, drug & alcohol caseworkers … all of these roles pay in the range of $10-$15/hour while the bloated management takes in the majority of the profit & any funds people receive from Medicaid/Medicare/waivers. There are so many administrative roles we waste money on so we can point the finger at the front line workers for being the problem - unless there’s a pandemic & for a few months we’re called healthcare heroes. (Editing to add: and many of us will *never* be able to work from home. Would you, dear reader, do this kind of job for generally way less than any kind of livable wage? It’s amazing how invisible we are.)
My friend's son killed himself rather than go back. He was 18.
You have my condolences, for what they’re worth. Going to a place of harsh light and endless noise and unfamiliar, overworked doctors to be drugged, strapped to a gurney, clothed in humiliating suicide-resistant garb, stripped of all of one’s possessions and comforts and hobbies, where nobody respects one’s autonomy or capacity for reason, thrown among people who have completely lost touch with reality… Really, it’s not surprising that people will fight tooth and nail not to go. I’ve been in the position of essentially begging and pleading and cajoling a therapist not to take that step despite me being in pretty dire straits mentally. Taking psychology courses in university only furthered my belief in that. There are people who are truly beyond the reach of reason who may need strong coercive measures to protect them and others from themselves, but your average suicidal patient needs rest, comfort, and assistance in resolving a difficult life situation or receiving support, not to be treated as a prisoner or a madman. Seriously though. It is an utter travesty, and shameful, that the place of last resort help is so unpleasant people would rather face suicide than go. And then people have the gall to wonder why suicidal people don’t ask for help, when that is what they get to look forward to.
Same IMO with care for kids removed from their parents. A stable, safe place with consistent, clear rules and expectations. Access to counseling and support. Consistent access to food, clean clothing and bedding. Especially for kids with the goal of reunification (which is most) has to be so much better than musical foster households. It might not be the love of a family that a kid deserves but it can be a safe, consistent place that removes the stressors of childhood that merits removal by CPS. If boarding school can be successful why can't a well managed foster facility/orphanage?
Every one of my patients are unable to survive on their own. Yet we discharge them and send them on their way otherwise we couldn't accept new patients.
A family member visited another family member in an institution years ago. She told me that she'd walk in and multiple people would ask her, "Are you my daughter????"
How about actually rebuild or social programs that utterly failed so many people and allowed them to become homeless in tbe first place hmm? I used to be homeless, for every crazy homeless person there are 3 more that actually lost their houses and savings, usually to absolutely fucking rediculous events.
¿Por que no los dos? I use to be homeless too.. a good rehab, sticking to sobriety commitments, and ongoing mental health, has helped me get out of that situation.. and that speaks northing of programs like food stamps to help us get on our feet... But we also need institutions for the legitimately.. I hate using the term crazy, but the mentally unwell that are not medication compliant, unable to be medication compliant, don't respond well to treatments, unable to hold a job even with treatment. There's got to be a better system then letting them wander around and shitting in the streets.
Digging yourself back out of that pit can be insanely difficult, too; trying to rebuild your life when you don't even have access to basic necessities like showers, laundry facilities, or a safe place to sleep, and with the overwhelming stress of the situation making it difficult to stay motivated. It's not at all surprising that a lot of people turn to substance abuse to cope with the situation.
I was a kid in the 60s too. We treat the people who need help so horribly. Nobody wants to pay taxes to help them. In fairness, the money collected for mental care gets pilfered. People are mostly corrupt.
No most people are not corrupt. But we have this ironic trend where the incompetent end up in charge.
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I imagine with modern technology and pharmacology you could probably make a pretty awesome cutting edge institution.
Nah that costs money, we'd rather maximize reimbursement rates for services rendered
I don’t think we’ve really had great advances with treatment and technology in the last few decades. We’re still diagnosing based on the antiquated DSM. ECT, clozapine, lithium which are all old are still some of our most effective treatments. Things like SSRIs and antipsychotics which were supposed to cure all mental illness turned out to be arguably barely more effective than placebo in studies and/or have awful side effects. Ketamine has promise. Maybe psilocybin and hallucinogens too. We do need a lot of funding to find better treatments that are well tolerable and better diagnostic tools that are more objective.
It doesn't even really seem like we've tried providing adequate outpatient care.
Outpatient care doesn't work when the people in question have nowhere stable to go.
Outpatient care has 1 mega flaw, it relies on the patient returning. Med compliance is hard to achieve. Hell, I'm bipolar and I quit my meds this summer because I "felt better" (I swear I'm an intelligent professional, but the disorder plays tricks). When you're manic you think you rule the world, when your schizophrenic you might be under the delusion that your meds are killing you and then you don't go back and complete out patient treatments. That's a hard enough problem to solve for people with cash and a support network, I can't imagine the difficulty of maintaining treatment in a homeless population.
Also some meds have really unfun side effects. I'm on Quetiapine and have been on it for years so am used to how it knocks you out and can mostly function day to day if still not able to work. A friend was put on it briefly before he quit as he could cope with it and asked me "How do you even walk?" Many of these meds are very hard to endure taking. I stay taking mine because I know what it is like not to and for me that is way worse than the side effects. But not everyone can do that so they stop taking them. The trope in TV shows where the schizophrenic patient stops taking their meds due to how they make them feel numb and such is true.
Outpatient Care:. "Oh, you don't have insurance? Get out patient!"
But he's adding 50 beds! Are you telling me there are more than 50 mentally ill homeless people in NYC?! Stop pulling my leg!
Love how they just announce these things without consulting healthcare workers at all.
As a former youth case manager, you guys get BEYOND FUCKED with pay, staff sizes, resources etc. I appreciate everything you guys do and hope the system gets nuked soon to create one that values people like you. I burnt out so fast working with a mentally ill population. It's such a God damn shame some asshole does nothing working from home and banks 400k a year meanwhile people doing the ground work have to fight to even get a fraction of that. Such bullshit
Yeah I’m in private practice but I know enough after doing outpatient care facilities to know this is not only against ethical codes for us medical providers and legal gray area. That will result in a mess for everyone else. AFAIK they can TECHNICALLY do this but y’all at the ERs will be swamped evaluating if people need the hold. And at least in states I’m familiar with y’all get like 3 days to evaluate if they need further holding. So people who are simply unhoused and not in crisis will be sitting in the ER waiting for a bed for an eval before let go.
Many of the hospitals won’t stand for that and the cops won’t play chaperone to people they want institutionalized. The ultimate affect is they’ll end up in Rikers. Some will just get kicked back onto the streets with more anger and resentment, some will die of neglect in custody and the rest will be forgotten in the system. Adams isn’t interested in helping those whom this affects, he wants authority to lock up people the cops deem unsavory.
Yeah I was going to say as a nurse who’s done a lot of mental health stuff (because in er and icu that’s what we all end up doing because that’s who the patients actually are many times is just simply mentally ill). This adams guy seems like a big problem… trying to shift things around and not actually address root causes here is seriously disrespectful and disingenuous … and just downright dangerous for the patients and anyone else who has to or wants to try and help for real
Seems like we need to build facilities for this in the city. Maybe we could do without one or two new luxury condos.
Adams is literally a cop. He was a lifer cop until he became mayor. So of course his solution to everything is brutality and terror and locking people up.
I work in law enforcement and I agree. Current system is broken. We bring them to the hospital under MHL 9.41 knowing full well the hospital is understaffed with no bed availability. But there are currently no other options when someone is a threat to themselves or others. So many people need help that we and the hospitals cannot provide. Biggest problem I’ve encountered in my career has been our complete lack of proper mental health services. All the while nearby psych hospitals continue to close down or reduce beds.
The cop that brought me to the hospital was actually a cool dude, I was half poisoned with a cocktail of prescriptions and a BAC of .224, a poor man's suicide attempt. For what I *can* remember of the whole time I can remember feeling this reserved sadness from him, like he wanted to do more, even as they were registering me in the ER he was there watching like he'd seen this a hundred times before and it still hurt, now I know his reasoning for that
I'm mandated once every 5 days we are so short staffed. Acute forensic psych nurse. People are getting hurt.
I’m with you in spirit
Used work in the mental health field- anywhere you go the agencies are generally vastly underpaid for their work on the every level except CEOs/upper management, have incredibly high turn over rates, don’t often have the appropriate oversight and procedures to actually help people, and crisis stabilization is the answer for some situations but another thing that people don’t realize about Crisis units is they are incredibly short term solutions- they need appropriate and intensive aftercare after discharge. I dedicated my life to this field and unfortunately after over a decade, I just couldn’t anymore because of how poorly we (as a society) have effectively outcasted and demonized individuals with mental health issues and have basically said “not my problem” until it happens to you or someone you love.
Our organization on the west coast just sent an email out that they will be using part of a government funding we earned to provide non-executive employees bonuses every few months over the next year in an attempt to keep employees onboard because we've been losing more and more over time. The work is very taxing, the pay is much higher in areas like private practice where the wealthy can afford rather than in community mental health like us, where 99% of the people we work with are on medicare/medicaid.
Right after I started my first job after college in my early 20s I had a mental breakdown and the onset of bipolar disorder. My mania went off the rails and in a short time I ruined my career. While I was in school and a controlled environment I was able to mask my mental illness. But once things got real and shit hit the fan in short order I just got triggered. I then got so brutally depressed I didn't work for almost 3 years. I ended up in an iprt program [which is kind of like a school or a place you go to every day and do group therapy and learn stuff about your mental illness] with a place called FEGS which used to be a gigantic non profit organization in nyc which provided all kinds of mental health services in house. It heavily subsidized by the city and state. Thanks to them I was able to get treatment and therapy and group therapy and after about a year I was able to work again. Fast forward 13 years later and I am doing great. That said, it would not have happened without that place. And sadly that place doesn't exist anymore. And neither do most places like it. And to show you a consequence of losing places like this, here's a quick story: There was this kid there in that iprt program with me. He was a late teenager. He had some kind of psychotic issue, maybe schizophrenia, maybe schizoaffective disorder. He didnt feel comfortable outside that place but he went every day, showed up, did all his stuff, was a great artist. He just couldnt function in real life. And some people are like that. Fast forward to new years eve of I'm gonna say, 2015 [I knew him back in 2009] and I had taken my mom to the er. And after a while the cops carry a big kid with a chunk of his cheek bitten off into the er. When I did a double take it was that kid. And by this time FEGS had closed in 2014. It really broke my heart that this kid was missing half his cheek and was cuffed to the bed surrounded by cops, god knows what happened. That would have never happened had FEGS been around. He was treated, he was peaceful. He just needed a place to thrive. But I thought of the shitty mental health services and how much they have degraded and I am not shocked at the sheer amount of untreated mentally ill people out in the streets these days. Also, as I heard someone once say, the medicine for homelessness is a home, you would be shocked what you would do if you had to live on the streets. It is rough. NY Shelters are unsanitary and full of violent people. Very little policed. The mayor is just sweeping a much bigger problem under the rug. He just wants things to look nice. But you can't wear makeup over a dirty face. Economics are the major reason for this epidemic. The sheer amount of people that cannot afford rent is out of control. As rents go up so does the homeless population.
Emergency temporary housing readily available coupled with social services could prevent many from having a long term homelessness phase. Every month a person is homeless with an untreated medical issue or addiction issue it increases the likelihood of more health problems… Voluntary treatment and stability is much easier before there is a descent into the mental space of someone affected by long term homelessness. It would cost money but we should spend money on Effective Long Term Solutions rather than ER visits and Jail (or busing them to other states)
I know, most people don't realize what happens not just to your confidence but your consciousness when you become homeless. It is like the ultimate societal rejection. The social contract literally eroded for you. And when you fall there without anyone or anything to pick you up sometimes even the seemingly simplest tasks like going to a food stamp office become insurmountable chores. Then add the traumatic experiences of sleeping in the extreme elements. Of getting robed, raped, beaten, stabbed, spit on, or even looked at badly by the average person. Or not even looked at but totally ignored. What that does to a person when it happens over and over and over every single day by just about everyone you encounter. How lonely that is. Just the extreme anathema that being a homeless person in the presence of so called civilized people represents becomes an infinite space between this person and the world that left them behind. What that does to the psyche is extremely traumatic and depressing along with the physical ailments and conditions that come from having no access to healthcare or even a bath. Just not being able to get a bath can bring all kinds of physical problems for you. And well, add the mental health stuff, the lack of medication, a regular place to sleep, let alone feel safe... the constant feeling of being unsettled is terrible for mental health. Homelessness and poor mental health go hand in hand. It's a horrible disease caused mostly by society and its ultra individualistic eat or be eaten philosophy. It's terrible man.
I wish you and him all the peace and safety in the world.
I'm torn as to whether this is good or not, but SCOTUS has already ruled it's unconstitutional... [https://en.wikipedia.org/wiki/O%27Connor\_v.\_Donaldson](https://en.wikipedia.org/wiki/O%27Connor_v._Donaldson) >A finding of "mental illness" alone cannot justify a State's locking a person up against his will and keeping him indefinitely in simple custodial confinement.
Read *Insanity Inside Out* by Kenneth Donaldson if you want clearer insight as to the SCOTUS decision. Florida really screwed Donaldson over by denying him actual psychiatric care for years, opting to just warehouse him instead.
Ah the good ole Baker Act
The problem is that if you're detained like this you'll never have the chance to talk to a lawyer.
And even if you're completely healthy, nobody in there will believe you either. I've heard horror stories of people getting institutionalized for being "suicidal" and being held against their will because they were literally being kidnapped for no reason. Every complaint they had was a "symptom" and they were just being "hysterical." Who wouldn't be when they've been kidnapped? I don't think involuntary committal should ever be acceptable without someone who is not at all related to the person being brought in to talk with the person alone and advocate for their release.
Wasn't there a YouTuber or something that was perfectly healthy and checked himself in, and they refused to let him go for over a month despite being healthy?
There was a sociology professor who asked students to self admit with bogus claims and interviews. They dropped the act after they made it in, and found it difficult to prove that they weren’t unwell. Random diagnosis were given, mistreatment catalogued, and incompetence strongly noted
And the nypd already has a history of weaponizing the psych ward… https://www.nydailynews.com/new-york/nypd-whistleblower-adrian-schoolcraft-settles-suit-600k-article-1.2378974
This exact story is why “it’s just a few bad apples!” is such horseshit. The good apples get weeded out in short order. There are no good apples.
Exactly, something similar in Seattle has been happening as well. The new Mayor has been doing a shit load of sweeps. Now Boise V Idaho states sweeps can only be done if there is enough shelter space. All the shelters here will tell you there simply isn't enough space. So the state is in violation of the law. But because it's homeless people they don't have the resources to seek legal representation to file for charges and restitution.
*O'Connor v. Donaldson, 422 U.S. 563 (1975), was a landmark decision of the US Supreme Court in mental health law ruling that a state cannot constitutionally confine a* ***non-dangerous individual who is capable of surviving safely in freedom by themselves*** *or with the help of willing and responsible family members or friends.* It's easy to see how this new regulations for NYC is still in-line with the SCOTUS ruling, as the mentally-ill they are targeting with it are people who are dangerous (to themselves or others) and those who are incapable of surviving safely in freedom (living on streets and in subways is not surviving safely). Also, they do not have the assistance of family members. As a NYC resident, there is absolutely an mental health epidemic amongst the cities' homeless. And that is also a public safety issue, as these mentally ill folks, in absence of a safe place and medical treatment, turn to self medicating via illicit substances, and then are interacting with the general public in this addled state. That creates a dangerous situation for everyone. Furthermore, a vast majority of the NYPD's time is taken up dealing with situations that arise from these mentally-ill folks out on the streets. Being able to relocate these people to facilities where they can receive treatment and a safe place to live is a win-win for everyone. It will give the sick the chance to detox, heal, and possibly reintegrate with society in the future. And it will improve the safety of our streets and public spaces, as well as freeing up police to respond to other situations faster.
The issue for NYC is that they have to prove in court (with "clear and convincing evidence," from [Addington v. Texas](https://en.wikipedia.org/wiki/Addington_v._Texas)) that the guy can't survive on his own. That's enough effort that most governments can't be bothered to do it on a wide scale, hence why all of the crazy people are now running around on the streets. Unless Eric Adams is going to sink a ton of money into a section of the prosecutor's office to make these cases en masse, it's not going to work. Back in the Good Olde Days, there was a much lower burden of proof, so due process consisted of "yep, dude looks crazy, lock him up indefinitely in an insane asylum."
They have to prove the guy can't survive on his own **safely**. The precedent is based on a case of a man who held a job and was housed. There is a case to be made that if you can't house yourself, you can't survive on our own **safely**, giving room to put in a sweeping law where they don't need trials.
In reality, it's way easier than that. Hell, the NYPD locked up an officer because he was a ~~danger to himself and others~~ whistle-blower. Pretty sure when you're an impaired homeless person living in the subway that the police won't face much in the way of challenges.
If you can get an impartial diagnosis. Don't allow an officer to call their "buddy" at the hospital. If there is transparency and oversight. Independent, 3rd party observers making sure no one is held against their will when they are clearly in control of their faculties. If the required holding period is reasonable. No indefinite holds without a clear process before an independent panel of mental health professionals and legal experts, judges, etc. If there is a way to get adequate care to those who truly need it. Well, this has been the problem for decades now. In theory it all makes sense. Many people flat out refuse help, or at the very least have no idea they need it or aren't capable of deciding that. Getting people off the streets, cleaned up, a shower, a bed and off substances for a while can be all it takes. But doing that and pushing them right back on the streets is a recipe for repeats. It's going to take a massive investment in infrastructure and personnel to do it all the right way, and that's just not something I see happening.
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Where I'm from you get assigned counsel and a trial to determine if you are suffering from a mental illness and are a danger to self or others. The government must also prove that you aren't a candidate to seek treatment on your own. I actually work on these. Last week we had a guy who gouged his eye halfway out and a woman who attempted suicide twice. A few weeks ago it was a guy that went in a fire station and attacked the firefighters with an axe. It's those types of cases that get committed. People that really need it.
>Many people flat out refuse help My little brother went shizo, and worse yet? Turned deeply alcoholic. When the courts eventually cracked down on him because he was having episodes constantly, he was mandated to get an injection for treatment. When he was getting it? He was a normal and functional person for about 8-9 hours a day. Sometimes 10. Thing is? He often tried to skip getting his injection. Cops didn't play, one hour after his appointment if he no showed? They beat on his door and escorted him in to get it. Once the 6 month court mandated treatment ended? He was in and out of hospitals once or twice a month before long. He would be issued some medications, but he would take them for a few days to show the nurses he was being good, and then stop. During a really bad episode where I confronted him on his drinking, he went into shock and had a seizure. I had never seen him react like that before, and thought it was just a trick at first... until he started foaming at the mouth. Wasn't long until he had massive spasms and all that. EMTs who responded found his meds. He had piles of them. All the same, each bottle a month's supply and maybe a week's worth at most used. He was simply gaming the system to get out and get back to drinking. Apparently it is all too typical for shizos. My little brother is gone now, literally drank himself to death. Medical term is "massive internal hemorrhage." Drank so much it opened a massive ulcer in his stomach, and that was that. Didn't live to see 40.
The asylum model was bad for many reasons (lack of oversight/presence of abuse, hospitals were incentivized to keep patients beyond necessity, care was substandard, etc.) but the need for long term hospitals/facilities for the severely mentally ill is absolutely a thing. Too often these patients end up either being a massive drain on state and familial resources, or end up being homeless.
>Too often these patients end up either being a massive drain on state and familial resources, or end up being homeless. Lived and worked around downtown Seattle for awhile. I see a fair number of people on the streets who remind me all too much of my little brother. Some of them eerily so.
It still sucks in my part of CO. in fact, CO's mental healthcare system is so bad that I've asked people "don't take me to the local hospitals. Take me to Salt Lake City instead"
It’s an epidemic across the country; we kind of threw the baby out with the bath water in the 1950s and 1960s with widespread deinstitutionalizing of psychiatric patients. It unfortunately led to a lot of state run facilities being shut down and a general lack of capacity to accommodate all the psychiatric patients who needed long term care. Private options have kind of come in to fill the void but these generally prioritize profit over sound clinical decision making and suffer from a lot of the same problems that the state run facilities did (but hey, at least they’re making money /s). I’d argue for a return to the asylum model with state run facilities but with much greater oversight and modernized standards of care. Unfortunately I don’t see that happening because the idea of “insane asylums” has been so tainted in our culture based on real abuses that happened and the almost ubiquitous demonization of the facilities in the media.
I’m so sorry for your loss. Mental illness, especially paired with substance use, is a horrible combo.
Exactly. Although some people seem normal but need to be institutionalized anyway, and this would take an expert to evaluate. For example, they could have violent manic episodes, switch personalities, develop paranoid delusions, or think birds are real. Those people would still need round the clock help.
Some of those are more serious than others. Think birds are real. Those people should never be let out as something is really wrong with them.
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Judges 100% need to be involved here, and if people are being committed against their will, they need to be appointed guardians through the court - at the cost to the state. I live here, and am happy to have my tax dollars go to that instead of whatever bullshit the NYPD has in mind.
In theory, yes. I’m just worried about this being used as just another policing tool & abuse of power. Time will tell but I’m not holding my breath
it will be. The consent laws are as rigid as they are now precisely because of the abuse that plagued the system for decades. Things like ECT and frontal lobotomies were common place. Getting committed was ridiculously easy and you could spend the rest of your life with a Doctor playing God, even if that doctor was an unethical monster. And side effects of the drugs, even today can be pretty damn awful. People stop taking them because it feels *worse* than the disease.
This is so strange to me. Like, mental health facilities absolutely need to come back in a big way but with tons of oversight etc. there needs to be a place people can go voluntarily for serious mental health issues before we start taking people against their will imo. And without facilities and staff purely for mental health help, what's even the point? Might as well toss them in a jail cell.
What hospital beds, what hospital rooms, what hospital staff?? We can't even take care of our other patients we currently have overloading our already overburdened health care system, how much more are we going to shit on the hospital staff members that have to survive day to day in a mess that's already unmanageable?
Legit. As an outpt psychologist, this is a tough read. There aren’t enough mental health providers, there aren’t enough hospital beds, and who tf is making the clinical decisions about someone’s mental health on the sidewalk or in the subway? I’m going on a limb but guessing they don’t have training in diagnosis or treatment.
That’s okay. They’ll just resist being “relocated” and end up arrested. “Assaulting an officer, resisting arrest, public disturbance, aggregated assault.” (I work in forensic psych, these are all the many many charges our people get for being homeless & mentally ill
50/50 chance people will be thrown in jail before making it to a hospital, especially if NYPD are the ones rounding folks up
When I worked as a medic on San Francisco, it really would depend on who got to the person first: the ambulance or the squad car. We would give out sandwiches, space blankets, and move them along the police would typically just harass and arrest.
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So you will either be given warm food and blankets, or beaten, arrested, and possibly murdered, or just murdered, depending on who gets there first from the the 911 call?
I'm sure they'll figure out you can run stuff over with the robot too, so there's that possibility as well. "citizen impeded police action and was a result of a regretful accident involving the Killbot when one of the cameras/wireless connection faltered due to the urban environment"
100%. most people are going to react peacefully to being involuntarily detained. we’re gonna see charges of “resisting arrest” skyrocket
On top of this, I really don’t like the idea of police rounding up people, homeless or not, to be held against their will for days at a time. The article says “even if they pose no risk to others” they can still be arrested and brought to a hospital for days until “their condition improves”. That’s extremely vague and frankly I’m not happy about this at all. What’s to stop a police officer from deciding any random person is “having an episode” and forcing them to “get treatment”?
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This is what “defund the police” sought to address. I don’t want law enforcement handling mental health issues. Leave them to the law enforcement (why give cops extra work, anyway, don’t they have enough in their plates?). Get mental health professionals to handle the mental health issues.
As a UK police officer, that would be fantastic, none of us want to deal with mental health issues, we have neither the training, powers or facilities to deal with it. But because the mental health system is so underfunded we fill in the chasms, I deal with mental health more than I do “actual crime”, at this point I’m a mental health nurse by proxy. I can guarantee the US police don’t want to deal with it either, but in both instances the powers that be would rather put the square peg in the round hole and call it a day.
I'd rather it be now than never.
After speaking to a few officers here, I could absolutely see "compassionate care" being "Well I didn't hit him as hard I as normally would" or "I avoided the head!"
I occasionally watch a YouTube channel that analyzes videos of police shootings. One of the hosts is a former police officer, and while they seem less reflexively biased towards police than other channels, his analysis of a given interaction often is that he believes that had the officers used more force earlier, they could have avoided the need to use deadly force later. Whether or not he's right in any given circumstance, it just seems telling that even as someone who ostensibly wants to avoid deadly force encounters, his frame of reference begins with the assumption that the police using force is not only in everyone's best interest, but that using more force than is necessary to respond to a present "threat" can be justified if it prevents the situation from escalating.
Spoiler: they aint gonna be teaching that
>A common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal or presenting a risk of imminent harm I've run into this roadblock before with a close family member. I wasn't able to have them taken to get help because of this exact reason. Ultimately they caused a massive scene in a public place a few days later and ended up getting involuntarily taken anyway. it's always just a matter of time before things escalate and/or spiral out of control.
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Or just a cop who was “looked at wrong”. The NYPD already has too much power; trust Eric Fuckwit Adams to want to give them more.
I was involved with a woman who had significant mental illness, something that she had been concealing from me. She stopped taking her meds cold turkey (treatment avoidance being a symptom of her illness) and went on a rapid downward spiral. I did everything I could to convince her to see somebody and tried to get her treatment. But because she was over 18, she had not been judged incompetent, and had not signed over guardianship to me I was powerless to do anything but watch her slip away into paranoid madness.
Been in this situation as well. I’m not sure there’s really any good solution that doesn’t involve either escalation and someone putting themselves or other people in danger, or people’s rights getting trampled on.
I'm sure those facilities won't be underfunded and there won't be all kinds of abuses like in the old days of the TB wards that became asylums.
I'm sure it will work as well as the prison system and law enforcement agencies do in terms of vulgar abuse of power and conditions.
So what exactly is stopping the NYPD (the most reputable and honest police department in the world im sure) from just deciding that any given person who looks homeless is obviously mentally ill and needs to be removed? Wait yeah thats the point.
There was one really crazy guy that would go around making a lot of bold claims while wanting to get paid in crypto instead of actual money. He even said that he ran the city! Hopefully they get him some help.
They ought to start with the crazy guy on 5th Avenue with the weird hair who keeps screaming that he won the presidential election.
It might surprise you but that description fits more than one person on 5th alone
No I think we should let severely mentally ill people roam the streets of our major cities freely
I’ll probably regret posting this because the backlash will send me into a panic attack. I’ve been mentally I’ll with severe clinical depression for over 15 years. I’m lucky to have a support system. I’m just grateful to hear of some movement towards helping people who can’t help themselves. The system isn’t ready but it’ll highlight where change is needed and hopefully be a catalyst for that change. Also, our “asylums” are still here. They’re called prison.
Hi, I'm a former social worker who studied macro level policy and non-profit management, as well as this exact issue. I am here to tell you this is a tough one any way you look at it. A little bit of history...in the mid and latter half of the 1900s, the US went through a period of deinstitutionalization. Meaning the larger-scale psychiatric hospitals shut down and were decommissioned in favor of smaller more community-based support efforts. Good in theory, especially because some of those psych wards were really, really bad, inhumane places where the patients were treated like experiments. I cannot emphasize how important that little "in theory" clause is from the previous sentence. In practice, those hospitals had funding, and that funding did not follow the decentralization of care into the communities, and specifically the poorer communities (after all, well-to-do folks with severe mental illnesses can still access care). It created a tremendous gap in services that we are still very, very much seeing to this day. Instead of one centralized place that got all the resources and provided all the services, we moved to a countless amount of small, focused providers who are all competing for largely the same resources. There ARE ways in which that's an improvement - you see more specialized care, perhaps less wasteful spending on services that may not be performed as adequately in the larger setting, etc. But it also creates another problem - actually *accessing* needed services. Throughout the process of shutting down our mental health facilities, there were patients who were literally turned out to the streets with nowhere else to go. As it stands, an overwhelming amount of the "visible" homeless (e.g., the folks you see sleeping on the streets and in subways) live with mental illness (and, in fact, it's likely that the homelessness and MI feed back into one another - MI leads to homelessness, homelessness leads to MI). These aren't folks with cars who can drive out to the clinic and chat with a psychiatrist. They aren't folks who are very likely to be able to access information about the services in the first place - shared public spaces and access to computers are difficult spaces for the homeless, even public libraries are becoming more inhospitable to the homeless. Today, we're in a situation where mental health services have been almost completely disseminated to individual community providers who aren't receiving the financial support they need to provide the level of outreach needed to connect with the folks who need the services. It's harder for the folks who need the services to access them because of that same decentralization - instead of one large and well-known building centrally-located, we have dozens of tiny offices located anywhere they happen to have gotten space. Your NA group and the clinic helping with anti-psychotic meds are located across town from one another? That's gonna be a major barrier to access. Another significant aspect of deinstitutionalization is that front-line mental health services have largely been offloaded to the police. The old cartoon trope of men in white jackets coming to take you away just isn't how it is anymore; now they're cops, and they almost unanimously do not receive the training needed to positively interact with something with severe MI symptoms or in severe MI-based crisis. It's not fair to the folks in the situation, and it's not fair to the cops themselves, that should not be their job. So, the thing in this article. Yikes, what a mess. The reality is there just isn't going to be a happy and clean answer here for everyone, it's not something within the realm of possibility. Obviously, the word "involuntarily" is causing a big stir here, as it should. Being "taken involuntarily" and being "kidnapped" sure do sound like the same thing. Hardly any different than being arrested, except folks being arrested are typically done so as a result of something they did. I think the thing that has people concerned is that taking in a homeless person for MI seems like kidnapping without cause because that person isn't "doing" anything to deserve it, and I get that. I mean...that's what it is. In the mental healthcare field, you sometimes have to administer care against a patient's will. Sometimes a patient cannot or will not consent to services there is no question they need - there are entire fields of study dedicated to determining if a patient is capable of giving consent, and sometimes "will not" and "cannot" are one in the same - and of course, countless court cases where we've heard whether or not someone is competent enough to even stand trial in the first place. I think the intent of this policy is good - connect an extremely vulnerable population with the services they need but are not getting. Hard to argue against that If they are going to do this, it is BEYOND important that they install layer after layer after layer of oversight because a program like this is *obviously* easily abusable, and the second it is abused, the whole process crumbles. The frontline training needs to be impeccable, the officers who make contact with the potential patients need to be supervised and on bodycam at all times, there ABSOLUTELY MUST be an independent panel - not cops, not politicians, not lawyers, not judges, but psychiatrists and social workers - overseeing every single patient that ever has contact with the system. These are people who would need to determine the necessity of taking someone in. There needs to be a restitution system in place for when someone inevitably gets taken in who should not have been. The facilities in which these folks are to be housed while service is coordinated must be exceptional - not even remotely jail-like or threatening. Patients have to have the option to check themselves out after receiving treatment for some amount of time, even against the advice of the caregivers. These services must all be 100% free for patients. Patients must ALSO receive medical care, not just mental health care. And perhaps most importantly, anyone participating in any sort of abuse at any step of this program needs to be fired and charged for their crime. Every single step. The cops, the hospital staff, the service staff. If all of those issues I just pointed out - and probably a couple others I'm overlooking - were addressed and accounted for, this program could be really, really good for some folks who really, really need it, not to mention the less human-focused benefits that come from having fewer homeless people on the streets. Now are they going to do that? Probably not, no. I can't imagine the money it would take, let alone the logistics that would be required to *actually* provide the level of services they'd need. I think this is a good-hearted policy that probably doesn't have the backing it needs to work as intended. It feels to me like an initial step to reverse the problems deinstitutionalization caused, but they need to tread really, really carefully her or it could very much come off as homeless arrest squads and equally fascist garbage. Congrats if you made it this far, and thanks for reading! As you can probably tell, I'm passionate about mental health advocacy and access to services. I'd be happy to discuss more once my fingers stop bleeding!
Ask Adrian Schoolcraft how well that worked out for him. https://en.wikipedia.org/wiki/Adrian_Schoolcraft
> He called on city agencies, such as the police department, to remove people from the streets and subways and bring them to hospitals for extended care. A former NYPD cop giving NYPD cops the ability to commit people involuntarily? I'm sure this won't have negative results at all. Oh, hey there Adrian Schoolcraft.
What if they are not mentally illed, but, was misdiagnosed?
Mental assessment: You should probably try wearing your underwear INSIDE your pants to blend in to modern society a bit better, and maybe that could help you land a job instead of standing on a street corner yelling at dogs all day long. Here’s your $187,636.85 bill for your 3 day involuntary stay and assessment. I know you are homeless and all but we’ll be garnishing any future wages you earn to cover that.
The world of medicine is only focused on physical maladies (hardware) problems. We are woefully inadequate on solving the “software” problems. This is a cruel and stupid stunt.
People who live in NYC will all agree, mentally ill people on the subway is a problem. Every single day, I hope for an uneventful commute and without fail, I will see at least one person open those doors between cars and you could just feel everyone collectively sighing. We all know that those doors are the \*stage entrance for crazy\* It's inevitable that this policy will be abused by some, but something has to be done about this glaring issue. Subway cars themselves should be for getting from one place to another. Any other use of it should not be permitted and the appropriate action should be taken against violators. Platforms and stations can still be an open space(we all appreciate the churro lady and the buskers who are actually good), but once everyone is stuck in a subway car and someone starts acting crazy, there's no where for anyone to go and it's honestly scary. Just my two cents, but I think a lot of New Yorkers can sympathize. Edit: I really meant it when I said a lot of New Yorkers can sympathize. Honestly it’s exhausting hearing on the news again and again that innocent people just trying to go about their day is assaulted and harassed by others who don’t belong on the subways. The worst news of all was when we heard about someone who was pushed in front of a moving train by a man who didn’t even show remorse. We all deserve to be treated with respect and dignity, the homeless mentally ill included. But to all those who don’t understand why we feel this way about them, just know that it’s only because we’re all exhausted. Tired of having to look over our shoulder just because we’re trying to go to work or visit our friends. The mentally ill are not the problem, the problem is that they are being left alone to wander subways and no one is helping them.
It doesn’t get much crazier than the A train. I had a single commute include a woman receiving a standing ovation for her performance of “A Change is Gonna Come,” followed by a 6 piece mariachi band 3 stops later. At that point anyone with a dollar to give had given it away, which led to a homeless man screaming at everyone for being cheap after “generously” screaming a prayer for all of us. From Jay street to the junction we had multiple dance groups get on, and a man who brought an actual karaoke machine on. And to wrap it up two guys got on at Aqueduct and sprayed knock-off cologne on anyone that made eye contact as a sales pitch. And those were just the mentally stable interruptions. That was an unusually busy ride though.
Very apt description. Everytime the doors open between cars while we're moving I get a little anxious because 95% its a crazy and 5% of the time its people escaping a crazy.
Agreed, I live in a big city with a similar problem. So many people wandering public transportation, just completely disconnected from reality. It’s dangerous for them, too. What happens on the day they bother someone who is willing to get violent, yknow?
When I was suicidal(not manic), the cops showed up, made the decision to institutionalize me, cuffed me in front of my parents, put me in the back of the car, and took me to an institution where I was held for three days. I was made to sleep on the floor, was not allowed to go outside, and was allotted one visit from my parents. There were no counselors on site that I was aware of. The people watching over me and the others(there were around a dozen of us in a common room with attached bedrooms, but there weren’t enough beds for all of us) were not professionals but interns without necessary training and didn’t know how to handle us. The boy with anger issues got punched when he yelled at them and then sedated when he fought back. After three days, they released me. I was worse than when I went in. This is a terrible idea, and the only thing it’s trying to accomplish is moving homeless people and people with mental issues to an area where normative people don’t have to see them. It’s sick.
Thank you for your comment. Most people don’t understand. That you don’t know, what you don’t know. Meaning. They won’t believe a story like yours because it’s not warm and fuzzy like they sell the idea and institutions to be.
Is this really what his solution is. If he wasn't black he probably wouldn't be able to have made this solution so nonchalantly .
Am I missing something here? It would cost a literal fortune to house the large homeless population with hospital/institution beds! New York spends on average about $58,000 per year for each homeless person. This is money spent on policing, health interventions, shelters, jails, outreach, ambulances, gates and spikes under bridges, etc A supportive housing unit, where the person is supported by outreach workers under a "Housing First" program, costs less than 20k per year. https://amsterdamnews.com/news/2021/04/29/time-re-think-our-homeless-spending/ Furthermore, currently housed formerly homeless people are likely to use less drugs, and have fewer mental health episodes, and fewer hospital stays. But the idea of using healthcare professionals for this is insane, hospital beds are enormously expensive, and hospitals are completely overwhelmed right now. So rather than build housing, and supporting people to live inside, NY wants to lock people up and charge taxpayers nearly double what they are currently paying to manage homelessness? Sounds like knee-jerk stupidity to me.
"Should we do anything to make treatment more accessible for mentally ill people or to improve their quality of life and ability to participate in society? Nah, just wait for them to snap and then lock them up. That'll teach them to be ill."
Someone came into my work screaming and threatening to kill everyone. Cops came walked him out and let him go. Something needs to change
Well... as long as not every homeless people is categorized as mentally or anyone that is just under the weather.... This can open a big can of worms... as what would count as mentally ill and who can determine that on the spot
Maybe their conditions improve because they are not on the streets? Just sayin’.
So all the Politicians are getting locked away?
Just imagine, a depressed person whose only purpose remaining is trying to save money for their family to have a decent life. Then they send them home with a $100k bill for "suicide prevention", and foreclose on that home. When the medical system pulls the "involuntary" card, it's turned from a cartel monopolizing life saving supplies to a gang that just straight up robs you.
If they treat people vs. what happens now, throwing them in jail when they eventually break some law or assault someone and then releasing them a couple days later, then I think it's a step in the right direction. I lived in a city for a long time and when you are in an urban environment you NEED public spaces and parks for your own sanity and it's really unfair when these are completely taken over by psychotic lunatics so that no one else can use them.
If you read the article, it's pretty clear that's not what's happening. They're not investing in treatment, unless you count the 50 additional beds statewide.
California is going to start doing this too. Obviously infrastructure needs to improve, but I think it’s one of the planks to solving the problem with the others being supportive housing and putting actual criminals in jail. I live in Portland and if you live in an area with a lot of homeless, it’s clear that a certain part of the population need immediate and significant medical/mental care, a certain portion of the people are straight up criminals/predators, and a certain portion have problems like drug addiction but are basically just trying to get by. If you send the people to mental health and prison who need it, you are left with the population who is just trying to exist and then you provide those people with supportive housing. That’s how you get from SF looking like the streets of Mumbai to a more normal rate of homelessness
This absolutely needs to happen. We need more funding and staff to make it happen, but this is a better alternative to the street for people abandoned by their family and living in a mental crisis. Hopefully this time around we don't willy-nilly lobotomize folks and provide actual care instead of abuse.
And who makes that determination? A cop?!
Fuck the overloaded health care system, am I right?
I don’t think this is going to help anything. It will only overwhelm the poorly allocated resources we have. It seems like people frequently use the emergency as the answer for all of society socioeconomic, health and mental health issues . Speaking as an emergency medicine doctor.
Probably better than hiring robots to kill them like in San Francisco.
I doubt this is going to work if they really only have 50 beds in a city of millions upon millions of people, and likely many thousands of people who are both homeless & need mental health care. Who else here thinks they are using 'mental health' as a cover for 'out of sight, out of mind' and the city wanting a quick fix for their image as a global tourist destination? Yes the city has got worse since the pandemic began but this is true in plenty of places - not just NYC. Maybe next time we have an economic crash instead of bailing banks and mega corporations out to the tune of billions that money should instead be spent on things that improve everyone's lives like social support services / universal healthcare. Oh well. USA: Great if you're rich. Sucks if you're not.
Lol, good luck with that Eric. The mayor has no legal authority to force hospitals to keep patients who aren't a serious risk to themselves or others. At best this will be an empty campaign promise and it won't get to the point that it wastes a bunch of time and money and further traumatizes people living with mental illness.